Oscar Health, Inc. (OSCR): Lienzo del Modelo de Negocio [Actualizado en Ene-2025]

En el panorama en rápida evolución del seguro de salud digital, Oscar Health surge como una fuerza revolucionaria, reinventando cómo la tecnología puede transformar la experiencia del paciente y la prestación de atención médica. Al combinar sin problemas plataformas digitales de vanguardia con soluciones de seguro personalizadas, Oscar Health ha forjado un nicho único que desafía los modelos de seguro tradicionales. Su innovador lienzo de modelo de negocio revela un enfoque estratégico que prioriza el diseño centrado en el usuario, la integración tecnológica y la gestión de la salud basada en datos, lo que los convierte en un jugador destacado en el ecosistema de tecnología de salud cada vez más competitivo.

Oscar Health, Inc. (OSCR) - Modelo de negocio: asociaciones clave

Proveedores de atención médica y redes médicas

Oscar Health ha establecido asociaciones con las siguientes redes de salud:

Red	Número de proveedores	Cobertura geográfica
Sistema de salud de Mount Sinai	7.200 médicos	Área metropolitana de Nueva York
Clínica de Cleveland	3.500 proveedores	Múltiples estados
Red de cuidado de Cigna	5.600 profesionales médicos	Cobertura nacional

Compañías de tecnología y software

Las asociaciones tecnológicas de Oscar Health incluyen:

• Amazon Web Services (infraestructura en la nube)
• Plataforma en la nube de Google
• Twilio (Servicios de comunicación)
• Stripe (procesamiento de pagos)

Compañías de seguros y socios de reaseguro

Pareja	Tipo de asociación	Cantidad de cobertura
Munich re	Reaseguro	Capacidad de riesgo de $ 500 millones
Swiss RE	Cobertura catastrófica	$ 250 millones en exceso de protección de pérdidas

Capital de riesgo e empresas de inversión

Los principales socios de inversión incluyen:

• Fundador Fund - $ 165 millones de inversión
• Google Ventures - Compromiso de $ 88 millones
• Khosla Ventures - Financiación de $ 75 millones
• Catalyst general - inversión de $ 50 millones

Plataformas de salud digital y telemedicina

Plataforma	Servicios proporcionados	Interacciones de telesalud anuales
Salud de teladoc	Consultas virtuales	375,000 interacciones
Doctor a pedido	Servicios de salud mental	250,000 visitas virtuales

Oscar Health, Inc. (OSCR) - Modelo de negocio: actividades clave

Desarrollo de plataformas de tecnología de seguros de salud

Oscar Health invirtió $ 146.4 millones en gastos de tecnología y desarrollo en 2022. La compañía opera una plataforma de salud digital patentada que atiende a 1,2 millones de miembros en 19 estados.

Inversión tecnológica	Métricas de plataforma
$ 146.4 millones (2022)	1.2 millones de miembros
Cobertura de 19 estados	Usuarios de plataforma digital

Proporcionar servicios de salud digital personalizados

Oscar Health ofrece servicios de salud digitales personalizados a través de su aplicación móvil y plataforma web.

• Consultas de atención virtual: 375,000 interacciones de telesalud en 2022
• Seguimiento de salud digital: tasa de participación del miembro del 62%
• Recomendaciones de salud personalizadas generadas a través de algoritmos de IA

Gestión del procesamiento de riesgos y reclamos

Oscar Health procesó $ 3.2 mil millones en reclamos médicos durante 2022, con una tasa de eficiencia de procesamiento de reclamos del 94%.

Volumen de reclamos	Eficiencia de procesamiento
$ 3.2 mil millones (2022)	Tasa de eficiencia del 94%

Ofreciendo consultas de telesalud

Oscar Health realizó 375,000 consultas de telesalud en 2022, lo que representa un aumento del 42% respecto al año anterior.

• Duración promedio de consulta de telesalud: 18 minutos
• Especialidades cubiertas: atención primaria, salud mental, consultas especializadas
• Tiempo de respuesta promedio: 12 minutos

Diseño de productos de seguro innovadores

Oscar Health generó $ 1.7 mil millones en ingresos totales para 2022, con un innovador diseño de productos de seguro que contribuyen significativamente a la diferenciación del mercado.

Ganancia	Innovación de productos
$ 1.7 mil millones (2022)	19 planes de seguro únicos

Oscar Health, Inc. (OSCR) - Modelo de negocio: recursos clave

Infraestructura avanzada de tecnología de salud digital

La infraestructura tecnológica de Oscar Health a partir del cuarto trimestre de 2023 incluye:

Métrica de tecnología	Valor cuantitativo
Infraestructura de computación en la nube	Amazon Web Services (AWS): plataforma 100% basada en la nube
Inversión tecnológica anual	$ 87.4 millones en 2023
Tecnología Contado de empleados	387 profesionales de tecnología a tiempo completo

Análisis de datos y capacidades de aprendizaje automático

Las capacidades de análisis de datos de Oscar Health incluyen:

• Algoritmos de modelado de riesgo de salud predictivo
• Sistemas de seguimiento de salud del paciente en tiempo real
• Modelos de aprendizaje automático procesando 5.2 millones de puntos de datos del paciente anualmente

Datos e ideas de salud del cliente

Métrico de datos	Valor cuantitativo
Vidas cubiertas totales	1.2 millones de miembros (cuarto trimestre de 2023)
Procesamiento anual de datos de salud	372 terabytes de información de salud anónima
Certificaciones de cumplimiento de datos	HIPAA, SOC 2 Tipo II

Plataformas de software de seguros patentadas

Métricas de plataforma de software clave:

• Sistema de gestión de seguros personalizado
• Tecnología de procesamiento de reclamos en tiempo real
• Plataforma de participación de miembros digitales

Fuerte red de profesionales de la salud

Métrico de red	Valor cuantitativo
Proveedores de atención médica totales	74,500 proveedores en la red
Cobertura geográfica	19 estados con redes de salud activas
Proveedores de telesalud	12.300 profesionales de atención virtual

Oscar Health, Inc. (OSCR) - Modelo de negocio: propuestas de valor

Experiencia de seguro de salud impulsada por el usuario y fácil de usar

La plataforma digital de Oscar Health atiende a 1,2 millones de miembros a partir del cuarto trimestre de 2023. La aplicación móvil de la compañía tiene 845,000 usuarios mensuales activos con una calificación de 4.7/5 App Store.

Métricas de plataforma digital	2023 datos
Totales miembros	1,200,000
Usuarios mensuales de aplicaciones activas	845,000
Calificación de la tienda de aplicaciones	4.7/5

Recomendaciones de atención médica personalizadas

Oscar Health utiliza algoritmos de personalización impulsados ​​por la IA que generan 3,6 millones de recomendaciones de salud individuales anualmente.

• Evaluaciones predictivas de riesgos para la salud
• Sugerencias personalizadas de cuidados preventivos
• Recomendaciones de vía de tratamiento personalizadas

Precios de seguro transparentes y simplificados

Los costos promedio de plan individual mensual varían de $ 372 a $ 582, con límites máximos transparentes de bolsillo de $ 8,550 para individuos y $ 17,100 para familias en 2024.

Servicios de telesalud a pedido

Oscar Health brinda atención virtual 24/7 con el 92% de las consultas de telesalud resueltas sin un seguimiento en persona. El tiempo de consulta virtual promedio es de 12 minutos.

Rendimiento de telesalud	2023 métricas
Tasa de finalización de consulta virtual	92%
Duración de consulta promedio	12 minutos

Herramientas integradas de gestión de salud digital

El ecosistema digital de Oscar Health incluye la integración de dispositivos portátiles para 680,000 usuarios activos, con 2.4 millones de puntos de datos de salud rastreados mensualmente.

• Seguimiento de salud en tiempo real
• Insights de salud automatizadas
• Ecosistema de dispositivos conectados

Oscar Health, Inc. (OSCR) - Modelo de negocios: relaciones con los clientes

Aplicación móvil e interfaz digital

La aplicación móvil de Oscar Health tiene más de 500,000 usuarios digitales activos a partir del cuarto trimestre de 2023. La aplicación admite la gestión de seguros de salud en tiempo real con una calificación de usuario de 4.2/5 en las tiendas de aplicaciones.

Métricas de plataforma digital	Datos de rendimiento
Descargas de aplicaciones móviles	750,000
Usuarios activos mensuales promedio	385,000
Tasa de procesamiento de reclamos digitales	87%

Coaching de salud personalizado

Oscar Health ofrece entrenamiento de salud personalizado a través de 125 profesionales de la salud dedicados.

• Duración promedio de interacción de entrenamiento: 45 minutos
• Sesiones de entrenamiento de salud digital: 42,000 anuales
• Tasa de satisfacción del miembro: 93%

Atención al cliente 24/7

Los canales de atención al cliente incluyen teléfono, correo electrónico y chat digital con tiempos de respuesta con un promedio de 7 minutos.

Canal de soporte	Volumen de contacto anual
Soporte telefónico	1.2 millones
Chat digital	680,000
Soporte por correo electrónico	320,000

Canales de comunicación digital directa

Oscar Health utiliza estrategias de comunicación digital multicanal que alcanzan el 92% de la base de miembros.

• Notificaciones de SMS: 1.5 millones mensuales
• Comunicaciones por correo electrónico: 2.3 millones mensuales
• Mensaje en la aplicación: 890,000 interacciones mensuales

Monitoreo y participación de la salud proactiva

Seguimiento avanzado de salud digital con 340,000 miembros utilizando activamente herramientas de monitoreo.

Herramienta de monitoreo	Compromiso de usuario
Integración de seguimiento de fitness	215,000 usuarios
Manejo de enfermedades crónicas	125,000 usuarios
Alertas de cuidados preventivos	98% de participación de miembros

Oscar Health, Inc. (OSCR) - Modelo de negocio: canales

Aplicación móvil

A partir del cuarto trimestre de 2023, la aplicación móvil de Oscar Health tiene 230,000 usuarios mensuales activos. La aplicación admite el 87% de las interacciones de seguro de usuario. Las estadísticas de descarga muestran 425,000 instalaciones totales de aplicaciones en las plataformas iOS y Android.

Módulo de aplicación móvil	Datos específicos
Usuarios activos mensuales	230,000
Instalaciones totales de aplicaciones	425,000
Soporte de interacción de usuario	87%

Plataforma web

La plataforma web de Oscar Health procesa el 62% de las interacciones miembros. El tráfico web mensual promedia 415,000 visitantes únicos. La administración de cuentas en línea cubre el 93% de los requisitos de servicio de los miembros.

Métrica de plataforma web	Datos específicos
Visitantes únicos mensuales	415,000
Interacciones miembros procesadas	62%
Requisitos de servicio cubiertos	93%

Servicios de telemedicina

Oscar Health brinda a los servicios de telemedicina 78,000 consultas virtuales mensualmente. La duración de la consulta promedio es de 12 minutos. El 64% de las interacciones de telemedicina se resuelven sin intervención médica en persona adicional.

• Consultas virtuales mensuales: 78,000
• Duración de consulta promedio: 12 minutos
• Tasa de resolución de consulta: 64%

Equipo de ventas directas

Oscar Health mantiene un equipo de ventas de 340 representantes directos. El costo promedio de adquisición de clientes es de $ 285. La tasa de conversión del equipo de ventas es del 22% para los planes de seguro de grupos individuales y pequeños.

Métrica del equipo de ventas	Datos específicos
Representantes de ventas directas	340
Costo de adquisición de clientes	$285
Tasa de conversión	22%

Marketing digital y publicidad en línea

Oscar Health asigna $ 4.2 millones mensuales al marketing digital. La publicidad en línea llega a 3.1 millones de clientes potenciales. Las tasas de clics promedian 2.7% en las plataformas digitales.

• Presupuesto mensual de marketing digital: $ 4.2 millones
• Alcance potencial del cliente: 3.1 millones
• Tasa de clics de publicidad digital: 2.7%

Oscar Health, Inc. (OSCR) - Modelo de negocio: segmentos de clientes

Buscadores de seguro de salud individual

A partir del cuarto trimestre de 2023, Oscar Health atiende a aproximadamente 1,2 millones de miembros individuales en 21 estados. La edad promedio de los buscadores de seguros individuales tiene 38 años.

Segmento de clientes	Totales miembros	Edad promedio	Extensión geográfica
Seguro de salud individual	1,200,000	38	21 estados

Consumidores jóvenes y expertos en tecnología

Oscar Health se dirige a los Millennials y a los consumidores de la Generación Z, con el 62% de sus usuarios digitales entre 25 y 44 años.

• Descargas de aplicaciones digitales: 500,000 a partir de 2023
• Tasa de compromiso móvil: 73%
• Edad de usuario digital promedio: 32 años

Empresas pequeñas a medianas

Oscar Health atiende a aproximadamente 15,000 clientes comerciales pequeños a medianos en 2024.

Segmento de negocios	Total de clientes	Tamaño promedio de la empresa	Ingresos anuales de prima
Seguro de salud de SMB	15,000	50-250 empleados	$ 245 millones

Profesionales de trabajo por cuenta propia

Oscar Health cubre aproximadamente 85,000 profesionales por cuenta propia en 2024.

• Membresía independiente: 85,000
• Premio mensual promedio: $ 487
• Industrias primarias: tecnología, creatividad, consultoría

Individuos conscientes de la salud

Oscar Health atrae a los consumidores conscientes de la salud a través de programas de bienestar digital.

Programa de bienestar	Participantes activos	Tasa de compromiso	Mejora de la salud promedio
Seguimiento de bienestar digital	350,000	65%	Mejora del 12% de las métricas de salud

Oscar Health, Inc. (OSCR) - Modelo de negocio: Estructura de costos

Desarrollo y mantenimiento de la tecnología

Inversión tecnológica anual: $ 87.3 millones en 2023

Categoría de gastos tecnológicos	Costo anual
Desarrollo de software	$ 42.1 millones
Infraestructura en la nube	$ 18.5 millones
Ciberseguridad	$ 12.7 millones
Mantenimiento de la plataforma digital	$ 14 millones

Gastos de red de proveedores de atención médica

Costos totales de gestión de la red: $ 156.2 millones en 2023

• Credenciales de proveedor: $ 23.4 millones
• Negociaciones del contrato de red: $ 41.6 millones
• Gestión de la relación de proveedor: $ 31.2 millones
• Costos de expansión de la red: $ 60 millones

Procesamiento y gestión de reclamos

Gastos de procesamiento de reclamos totales: $ 112.5 millones en 2023

Componente de procesamiento de reclamos	Costo anual
Tecnología de procesamiento de reclamos	$ 37.8 millones
Personal de adjudicación de reclamos	$ 44.3 millones
Sistemas de detección de fraude	$ 15.4 millones
Análisis de reclamos	$ 15 millones

Marketing y adquisición de clientes

Gastos totales de marketing: $ 64.7 millones en 2023

• Publicidad digital: $ 22.3 millones
• Publicidad de medios tradicional: $ 15.6 millones
• Programas de referencia de clientes: $ 8.9 millones
• Personal de ventas y marketing: $ 17.9 millones

Cumplimiento regulatorio y operaciones de seguro

Cumplimiento total y costos operativos: $ 93.6 millones en 2023

Categoría de gastos de cumplimiento	Costo anual
Consultoría legal y regulatoria	$ 35.2 millones
Tecnología de cumplimiento	$ 24.5 millones
Licencias y tarifas regulatorias	$ 18.9 millones
Capacitación de cumplimiento	$ 15 millones

Oscar Health, Inc. (OSCR) - Modelo de negocios: flujos de ingresos

Primas de seguro de salud

En el tercer trimestre de 2023, Oscar Health reportó ingresos totales de $ 713.4 millones. Las primas del seguro de salud representaban la fuente de ingresos primario, con aproximadamente $ 687.2 millones generados a partir de colecciones de primas.

Categoría de ingresos	Cantidad (tercer trimestre 2023)	Porcentaje de ingresos totales
Primas de seguro de salud	$ 687.2 millones	96.3%

Tarifas de consulta de telesalud

Oscar Health generó aproximadamente $ 15.3 millones a partir de los Servicios de Consulta de Telealth en 2023.

Servicios de información y análisis de datos

Los servicios de análisis habilitados para la tecnología de Oscar Health generaron aproximadamente $ 6.5 millones en ingresos para 2023.

Tipo de servicio de análisis	Contribución de ingresos
Insights de datos de atención médica	$ 4.2 millones
Análisis predictivo	$ 2.3 millones

Licencias de plataforma de tecnología

La licencia de la plataforma de tecnología generó $ 3.7 millones en ingresos para Oscar Health en 2023.

Servicios de salud de valor agregado

Los servicios de salud adicionales contribuyeron con $ 4.9 millones al flujo de ingresos de Oscar Health en 2023.

• Programas de manejo de enfermedades crónicas
• Coordinación de atención personalizada
• Servicios de apoyo a la salud mental

Servicio de valor agregado	Contribución de ingresos
Manejo de enfermedades crónicas	$ 2.1 millones
Coordinación de la atención	$ 1.8 millones
Apoyo de salud mental	$ 1.0 millones

Oscar Health, Inc. (OSCR) - Canvas Business Model: Value Propositions

You're looking at the core offerings that Oscar Health, Inc. (OSCR) is pushing to win members in the individual market as of late 2025. The numbers show a company scaling rapidly, ending Q3 2025 with over 2.1 million members, a 28% year-over-year growth in that quarter alone.

Technology-driven simplicity and transparent pricing for consumers

Oscar Health's value proposition centers on its proprietary +Oscar platform, which aims to make the complex world of health insurance straightforward. The technology is designed to drive operational efficiency, evidenced by the company's Selling, General & Administrative (SG&A) expense ratio guidance for the full year 2025 being in the range of 17.1% to 17.6%. Furthermore, the AI tools within the platform, like Care Guides, reportedly reduce member response times by 90% via its Virtual Urgent Care service. The success of the consumer-facing experience is reflected in the Hola Oscar offering, which boasts an industry-leading Net Promoter Score (NPS) of 87.

$0 virtual primary and urgent care on most plans

For many members, access to immediate care is simplified with zero out-of-pocket cost. The Guided Care HMO plans specifically include $0 virtual urgent care visits and $0 for medications.

Specialized plans like Buena Salud for Hispanic/Latino members

Oscar Health targets specific demographic needs with culturally relevant products. The Buena Salud plan is a Spanish-first solution for Hispanic and Latino members, a group that accounts for close to one-third of Oscar Health's total enrollment. This specialized experience builds upon the Hola Oscar offering, which carries an NPS of 87.

Multi-condition plans to lower costs by 25% or more for chronic illness

For the significant portion of the ACA population managing complex health issues, Oscar Health offers plans designed to consolidate care and reduce spending. The multi-condition plan, targeting members with diabetes, pulmonary, and cardiovascular disease, is projected to lower related costs by 25% or more.

Here are the specific cost-reducing features baked into these specialized plans:

• $0 cardiologist, pulmonologist, and endocrinologist visits.
• $0 screenings and labs.
• $0 primary and behavioral care.
• $0 medications.
• A $100 out-of-pocket monthly maximum on insulin.

Dedicated Concierge Teams for personalized navigation and support

Personalized navigation is delivered through dedicated teams. While a specific team size isn't available, the high satisfaction scores suggest effective navigation. The Hola Oscar experience, which connects members to a care team, achieved an NPS of 87.

The quantitative value delivered across these propositions can be summarized as follows:

Value Proposition Metric	Associated Number/Amount	Data Context/Plan
Total Membership (as of Q3 2025)	2.1 million members	Scale of consumer base
Cost Reduction for Multi-Condition Care	25% or more	Average annual savings for CKM syndrome services
Virtual Care Response Time Improvement	90% reduction	Via AI tools in Virtual Urgent Care service
Spanish-First Program NPS	87	Industry-leading score for Hola Oscar/Buena Salud experience
Targeted Insulin Cost Cap	$100 monthly maximum	On select Chronic Care Plans
Targeted SG&A Expense Ratio (2025 Guidance)	17.1% to 17.6%	Reflecting technology-driven operational leverage

Finance: draft 13-week cash view by Friday.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Customer Relationships

High-touch, proactive engagement via dedicated Concierge Teams

Every member is assigned a dedicated Concierge team, which includes care guides and a licensed nurse, to provide expert clinical advice and plan guidance.

• Concierge teams help members find providers based on experience, member feedback, language, location, gender, and specialty.
• Support includes dealing with confusing bills, facilitating prior authorizations, and coordinating durable medical equipment and mental health services.
• Oscar has a dedicated concierge team for employees available 24/7 to help maximize new benefits.
• One client using health engagement campaigns saw a 118% year-over-year increase in annual wellness visits.

Digital-first self-service through the mobile app and online platform

Oscar Health, Inc. serves approximately 2.1 million members as of September 30, 2025.

The technology platform drives deep engagement, with members having access to features like viewing claims in real time and scheduling appointments.

Digital Metric	Value/Data Point
Total Members (as of Sep 30, 2025)	2,100,000
AI Agent Launch	Oswell, powered by OpenAI
Claims Auto-Adjudication Rate (Mar-May 2024)	98%
Health Engagement Campaigns Running Per Month	More than 200
Consumer Use of Patient Portals (General Market)	Two-thirds

The mobile app and website enable digital doctor visits and 24/7 telemedicine.

Virtual-first care models to drive engagement and lower cost of care

The company's technology stack and virtual care offerings aim to enhance member experience and reduce the cost of care delivery.

• Condition-focused plans for members with diabetes, COPD, asthma, and cardiovascular-kidney-metabolic syndrome can save approximately $800 a year.
• Managing these specific chronic conditions together can lower costs by 25% or more.
• Guided Care HMO plans offer $0 virtual urgent care.
• The SG&A expense ratio improved to 17.5% in the third quarter of 2025, compared to 19.0% in the third quarter of 2024.
• The SG&A expense ratio was 15.8% in the first quarter of 2025, the lowest quarterly ratio in the company's history.

Culturally-competent care via Spanish-first Hola Oscar experience

The Hola Oscar program connects Hispanic and Latino members to a care team and healthcare community that share their cultural background.

Oscar introduced Buena Salud, a Spanish-first solution building upon the Hola Oscar experience.

• The Hola Oscar experience has an industry-leading Net Promoter Score (NPS) of 87.
• These culturally-aligned communities make up nearly one-third of Oscar's membership.
• The Buena Salud solution prioritizes preferences of Hispanics and Latinos, who are more inclined to seek care when providers speak Spanish.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Channels

You're looking at how Oscar Health, Inc. gets its product-health insurance-into the hands of members as of late 2025. Their channel strategy is heavily weighted toward government-facilitated marketplaces but is actively pivoting toward employer-sponsored options via technology.

Affordable Care Act (ACA) Federal and State Marketplaces (Healthcare.gov)

The ACA marketplace remains the core distribution engine for Oscar Health, Inc. As of the 2025 plan year, Oscar Health, Inc. expanded its footprint to be available in 504 markets across 18 states. This focus on the individual market is significant, as the overall ACA marketplace grew from 11 million enrollees in 2020 to over 24 million as of 2025. Oscar Health, Inc. holds approximately 8% market share within this ACA segment as of late 2025. The company is actively building solutions for specific demographics within this channel, such as the Buena Salud offering designed for Spanish-speaking members, a group that accounts for close to one-third of Oscar Health, Inc.'s total enrollment.

Here's a look at the membership scale driving this channel:

Metric	Date/Period	Value
Total Membership	Q3 2025	2.1 million members
Individual & Small Group Membership	June 30, 2025	2,017,058 members
Total Membership	June 30, 2025	2,027,148 members
Effectuated Members (Approximate)	Q1 2025	2 million members

Direct-to-consumer sales via HiOscar.com and acquired direct enrollment platforms

The digital front door, HiOscar.com, is where members interact directly with Oscar Health, Inc.'s technology and plan options. This channel is crucial for driving enrollment in the ACA plans mentioned above, as individuals use Healthcare.gov or related state portals during the Open Enrollment Period to select Oscar Health, Inc.'s Bronze, Silver, and Gold HMO plans. The company's tech-first approach is designed to make shopping easy, which is key for direct acquisition. For instance, in Ohio, individuals can go to healthcare.gov during the 2025 Open Enrollment Period to select plans.

Independent insurance brokers and agents

While the search results emphasize the ACA marketplace and the emerging ICHRA channel, brokers and agents are the traditional backbone for many individual and small group sales. Oscar Health, Inc. is also expanding its reach to employees via employer contributions, which often involves brokers in the small business space. The company is working with StretchDollar to help businesses with fewer than 50 employees offer pre-tax contributions for individual health insurance, a move that leverages the growing ICHRA adoption. ICHRA adoption among small employers (less than 50 employees) was up 52% from 2024-2025.

The shift away from legacy partnerships is also notable in the distribution mix. The Cigna+Oscar co-branded partnership channel saw a sharp contraction:

• Cigna+Oscar Members (June 30, 2024): 58,293
• Cigna+Oscar Members (June 30, 2025): 10,090

+Oscar platform licensing to external payors and providers

The +Oscar platform represents a B2B channel where Oscar Health, Inc. monetizes its proprietary technology stack beyond its own insurance operations. This platform is a key component of the company's strategy, automating functions like claims processing. The platform automates 96% of claims under $30K at 98.5% accuracy. Revenue from this channel is grouped under Other revenues in financial filings, which also includes revenue from three companies acquired in May 2025. While a specific licensing revenue figure isn't isolated, the overall company revenue for the first half of 2025 reached $5.91 billion, with full-year 2025 revenue guidance set between $11.2 billion and $11.3 billion. This platform is central to the company's operational efficiency, contributing to an SG&A expense ratio that hit a record-low of 15.8% in Q1 2025.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Customer Segments

You're looking at the core groups Oscar Health, Inc. (OSCR) is targeting with its tech-enabled insurance products as of late 2025. This is where the rubber meets the road for their growth strategy.

Individuals and Families in the ACA Marketplace (primary focus)

This segment is the bedrock of Oscar Health, Inc. (OSCR). The overall Affordable Care Act (ACA) marketplace reached over 24 million enrollees as of 2025. Oscar Health, Inc. (OSCR) has captured a significant piece of this, growing its membership base to over 2 million total members as of the second quarter of 2025, and specifically to approximately 2.1 million members as of September 30, 2025. This represents an 8% market share within the ACA segment. The individual exchange membership saw a 45% year-over-year growth as of the first quarter of 2025. For context on the financial performance tied to this segment in Q1 2025, the company posted a net income of $275.2 million. However, the segment is facing pressure; for the second quarter of 2025, the Medical Loss Ratio (MLR) was 91.1%, and the full-year 2025 MLR projection was 86-87, reflecting higher morbidity levels among enrollees.

The table below summarizes key metrics for the primary customer base:

Metric	Value as of Late 2025	Source Context
Total Members (Approximate)	2.1 million	As of September 30, 2025
ACA Marketplace Share	8%	As of 2025
ACA Marketplace Size (Total)	Over 24 million lives	As of 2025
Q2 2025 Total Revenue	Approximately $2.9 billion	For the three months ended June 30, 2025
Projected 2026 ACA Market Size (Subsidy Expiration Scenario)	Approximately 18.2 million lives	From 24.3 million in 2025

Also, a significant portion of this membership is from specific demographic groups:

• Hispanic and Latinx members account for close to one-third of total enrollment.
• This population is noted as the fastest-growing in the ACA market overall.

Small Group employers transitioning to ICHRA models

Oscar Health, Inc. (OSCR) is heavily invested in the Individual Coverage Health Reimbursement Arrangement (ICHRA) channel for growth. Estimates put the total lives covered under ICHRA in 2025 between 500,000-1 million. This segment is showing adoption momentum:

• Small employer (less than 50 employees) ICHRA adoption increased 52% from 2024-2025.
• Adoption among larger employers (50+ employees) increased 34% in 2025.
• Retention is strong, with 88% of employers remaining on the program in 2025.

The CEO indicated that by 2025, they expected 'very, very positive results coming in' from this channel. The ICHRA structure allows small and mid-sized businesses to offer tax-free contributions for employees to buy their own individual coverage.

Consumers in 504 counties across the US

The geographic footprint for Oscar Health, Inc. (OSCR) in 2025 covers 504 counties across 18 states. This is a slight reduction from 512 counties in 2024. The company is actively introducing new market coverage, such as in Texas, Oklahoma, Missouri, Illinois, Michigan, Ohio, North Carolina, Georgia, and New Jersey for the 2025 plan year.

Members with high-acuity, multiple chronic conditions

Oscar Health, Inc. (OSCR) is specifically targeting members with complex health needs through specialized products. The company launched a multi-condition plan in 2025 designed for members managing diabetes, pulmonary conditions, and cardiovascular disease concurrently.

The value proposition for this high-acuity segment is significant cost reduction and specialized access:

• Internal analysis suggests savings of 25% or more are possible with this combined-condition plan.
• Benefits include $0 visits to a cardiologist, pulmonologist, or endocrinologist.
• The plan also includes $0 for screenings, labs, primary care, behavioral health care, and medications.

This focus addresses the observed trend where marketplace policyholders are presenting with more severe health needs than initially estimated as of Q2 2025.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Cost Structure

The Cost Structure for Oscar Health, Inc. is heavily weighted toward medical claims, which is typical for an insurance carrier, but also includes significant investment in its proprietary technology stack.

Medical expenses are the largest component, directly reflected in the Medical Loss Ratio (MLR). For the full year 2025, Oscar Health reaffirmed guidance projecting the MLR to be in the range of 86.0% to 87.0%. This elevated ratio is driven by higher average market morbidity. To give you a concrete look at recent performance, the MLR for the third quarter ended September 30, 2025, was reported at 88.5%, up from 84.6% in the prior year period. Medical expenses for that third quarter alone rose 29% year-over-year to $2.6 billion.

The Selling, General, and Administrative (SG&A) expenses show a trend of improving efficiency, even as the MLR pressures the bottom line. The 2025 full-year guidance for the SG&A expense ratio is projected to be between 17.1% to 17.6% of total revenue. For the nine months ended September 30, 2025, the SG&A expense ratio was 17.3%, an improvement from 19.0% for the same period in 2024. In Q3 2025 specifically, the SG&A ratio was 17.5%, down from 19.0% in Q3 2024, which management attributed to fixed cost leverage and disciplined cost management.

Here's a quick look at how the key expense ratios are tracking against the full-year guidance:

Metric	2025 Full Year Guidance Range	Q3 2025 Actual	9M 2025 Actual
Medical Loss Ratio (MLR)	86.0% to 87.0%	88.5%	84.8%
SG&A Expense Ratio	17.1% to 17.6%	17.5%	17.3%

Technology development and maintenance costs are embedded within operating expenses, but the return on this investment is quantified by the platform's capabilities. Oscar Health's proprietary +Oscar platform, launched in 2025, is a key cost-management tool. This technology infrastructure is designed to help partners automate processes, which in turn lowers the administrative cost base for Oscar Health over time. Specifically, the platform can automate 96% of claims under $30,000 with an accuracy rate of 98.5%.

Provider compensation and network management costs are the primary driver of the MLR. These costs are managed through network contracting and care routing initiatives. The company employs a proprietary routing engine technology aimed at claims deflation by directing members to lower-cost settings, such as urgent care centers instead of emergency rooms. The overall cost structure is sensitive to utilization patterns, as seen by the elevated utilization in Q2 2025, which contributed to the revised MLR guidance. The company is taking pricing actions for 2026 to reflect the higher acuity observed in the market.

The cost structure is also influenced by specific operational results:

• Q3 2025 Net Loss attributable to Oscar Health, Inc. was $137.5 million.
• Q3 2025 Loss from Operations was $129.3 million.
• The company issued $410 million in convertible senior subordinated notes due 2030 during Q3 2025.
• For the nine months ended September 30, 2025, the Loss from Operations was $62,610 thousand (or $62.61 million).

Finance: draft 13-week cash view by Friday.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Revenue Streams

You're looking at Oscar Health, Inc. (OSCR) and seeing a massive top-line number, but you need to know exactly where that money is coming from to judge the underlying health of the business. Honestly, the revenue streams are dominated by one core activity, but there are other important, albeit smaller, contributors.

Health insurance premiums from Individual & Family Plans make up the vast majority of Oscar Health, Inc.'s revenue. This is the money members pay for their coverage, primarily through the Affordable Care Act (ACA) marketplaces. This focus on the individual market is the engine driving the company's scale, which, as of September 30, 2025, included approximately 2.1 million members. The premium revenue is reported net of risk adjustment transfers, which is a key mechanism in the ACA exchanges to balance risk across insurers.

To give you a sense of the scale, look at the recent top-line performance. For the third quarter of 2025 alone, total revenue hit approximately $2.986 billion. For the first nine months of 2025, total revenue reached $8.90 billion.

Here's a breakdown of the components that make up that total revenue, based on the third quarter 2025 filing:

Revenue Component	Q3 2025 Amount (in thousands)	Q3 2025 Percentage (Implied)
Premium revenue (net of risk adjustment transfers)	$2,901,847	~97.2%
Investment income	$59,344	~2.0%
Other revenues	$24,793	~0.8%
Total Revenue	$2,985,984	100.0%

The second stream involves services and other revenue from licensing the +Oscar platform. This is where Oscar Health, Inc. monetizes its technology stack by offering it to other payers and partners. While it's a strategic area for future growth and margin improvement, it remains a small fraction of the total revenue compared to premiums, as shown by the Q3 2025 data where 'Other revenues' were only about $24.8 million.

The company's near-term financial outlook is anchored by its full-year projection. Oscar Health, Inc. reaffirmed its full-year 2025 Total Revenue guidance to be between $12.0 billion and $12.2 billion. This guidance reflects strong membership growth but is set against a backdrop of higher expected medical costs, with a projected Medical Loss Ratio (MLR) between 86.0% and 87.0% for the full year.

Finally, you must account for investment income from the company's cash and investment portfolio. With approximately $5.4 billion in cash and investments at the end of the second quarter of 2025, this stream provides a non-underwriting boost to the top line. For the third quarter of 2025, this income was reported at $59.3 million.

You should keep an eye on these key drivers:

• Premium revenue growth, which is tied directly to membership enrollment.
• The MLR, which dictates the gross profitability of that premium revenue.
• The growth rate of Other revenues, signaling +Oscar platform adoption.

Finance: draft 13-week cash view by Friday.