Oscar Health, Inc. (OSCR): Business Model Canvas [Jan-2025 Mis à jour]

Dans le paysage rapide de l'assurance maladie numérique en évolution, la santé d'Oscar apparaît comme une force révolutionnaire, réinvenant comment la technologie peut transformer l'expérience des patients et la prestation des soins de santé. En mélangeant de manière transparente les plates-formes numériques de pointe avec des solutions d'assurance personnalisées, Oscar Health a creusé un créneau unique qui remet en question les modèles d'assurance traditionnels. Leur toile de modèle commercial innovant révèle une approche stratégique qui priorise la conception centrée sur l'utilisateur, l'intégration technologique et la gestion des soins de santé basée sur les données, ce qui en fait un acteur remarquable dans l'écosystème de technologie de santé de plus en plus compétitif.

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: partenariats clés

Fournisseurs de soins de santé et réseaux médicaux

Oscar Health a établi des partenariats avec les réseaux de soins de santé suivants:

Réseau	Nombre de prestataires	Couverture géographique
Système de santé du mont Sinaï	7 200 médecins	Région métropolitaine de New York
Clinique de Cleveland	3 500 fournisseurs	Plusieurs États
Cigna Care Network	5 600 professionnels de la santé	Couverture nationale

Technologie et sociétés de logiciels

Les partenariats technologiques d'Oscar Health comprennent:

• Amazon Web Services (Cloud Infrastructure)
• Google Cloud Platform
• Twilio (services de communication)
• Stripe (traitement des paiements)

Compagnies d'assurance et partenaires de réassurance

Partenaire	Type de partenariat	Montant de la couverture
Munich re	Réassurance	Capacité de risque de 500 millions de dollars
Suisse re	Couverture catastrophique	Protection de 250 millions de dollars sur les pertes excédentaires

Capital-risque et sociétés d'investissement

Les principaux partenaires d'investissement comprennent:

• Fonds des fondateurs - Investissement de 165 millions de dollars
• Google Ventures - Engagement de 88 millions de dollars
• Khosla Ventures - Financement de 75 millions de dollars
• Catalyseur général - Investissement de 50 millions de dollars

Plateformes de santé numérique et de télémédecine

Plate-forme	Services fournis	Interactions de télésanté annuelles
Santé Teladoc	Consultations virtuelles	375 000 interactions
Docteur sur demande	Services de santé mentale	250 000 visites virtuelles

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: Activités clés

Développer des plateformes de technologie d'assurance maladie

Oscar Health a investi 146,4 millions de dollars dans les frais de technologie et de développement en 2022. La société exploite une plate-forme de santé numérique propriétaire desservant 1,2 million de membres dans 19 États.

Investissement technologique	Métriques de la plate-forme
146,4 millions de dollars (2022)	1,2 million de membres
19 États de la couverture	Utilisateurs de plate-forme numérique

Fournir des services de santé numériques personnalisés

Oscar Health propose des services de santé numérique personnalisés via son application mobile et sa plate-forme Web.

• Consultations en soins virtuels: 375 000 interactions de télésanté en 2022
• Suivi de la santé numérique: taux d'engagement des membres de 62%
• Recommandations de santé personnalisées générées par les algorithmes d'IA

Gérer le traitement des risques et des réclamations

Oscar Health a traité 3,2 milliards de dollars de réclamations médicales en 2022, avec un taux d'efficacité de traitement des réclamations de 94%.

Volume de réclamation	Efficacité de traitement
3,2 milliards de dollars (2022)	Taux d'efficacité de 94%

Offrir des consultations de télésanté

Oscar Health a effectué 375 000 consultations de télésanté en 2022, ce qui représente une augmentation de 42% par rapport à l'année précédente.

• Durée moyenne de la consultation de la télésanté: 18 minutes
• Spécialités couvertes: soins primaires, santé mentale, consultations spécialisées
• Temps de réponse moyen: 12 minutes

Concevoir des produits d'assurance innovants

Oscar Health a généré 1,7 milliard de dollars de revenus totaux pour 2022, la conception innovante des produits d'assurance contribuant de manière significative à la différenciation du marché.

Revenu	Innovation de produit
1,7 milliard de dollars (2022)	19 régimes d'assurance uniques

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: Ressources clés

Infrastructure de technologie de santé numérique avancée

L'infrastructure technologique d'Oscar Health au Q4 2023 comprend:

Métrique technologique	Valeur quantitative
Infrastructure de cloud computing	Amazon Web Services (AWS) - Plateforme 100% basée sur le cloud
Investissement technologique annuel	87,4 millions de dollars en 2023
Décompte des employés de la technologie	387 professionnels de la technologie à temps plein

Analyse des données et capacités d'apprentissage automatique

Les capacités d'analyse des données d'Oscar Health comprennent:

• Algorithmes de modélisation des risques de santé prédictifs
• Systèmes de suivi de la santé des patients en temps réel
• Modèles d'apprentissage automatique Traitement 5,2 millions de points de données des patients par an

Données et informations sur la santé des clients

Métrique de données	Valeur quantitative
Lives couvertes totales	1,2 million de membres (Q4 2023)
Traitement annuel des données sur la santé	372 téraoctets d'informations de santé anonymisées
Certifications de conformité des données	HIPAA, SOC 2 TYPE II

Plates-formes logicielles d'assurance propriétaire

Métriques clés de la plate-forme logicielle:

• Système de gestion des assurances sur mesure
• Technologie de traitement des réclamations en temps réel
• Plateforme de fiançailles des membres numériques

Solide réseau de professionnels de la santé

Métrique du réseau	Valeur quantitative
Total des prestataires de soins de santé	74 500 fournisseurs en réseau
Couverture géographique	19 États avec des réseaux de soins de santé actifs
Fournisseurs de télésalités	12 300 professionnels des soins virtuels

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: propositions de valeur

Expérience d'assurance maladie conviviale et axée sur la technologie

La plate-forme numérique d'Oscar Health dessert 1,2 million de membres au quatrième trimestre 2023. L'application mobile de l'entreprise compte 845 000 utilisateurs mensuels actifs avec une cote de 4,7 / 5.

Métriques de plate-forme numérique	2023 données
Total des membres	1,200,000
Utilisateurs mensuels de l'application active	845,000
Note de l'App Store	4.7/5

Recommandations de soins de santé personnalisés

Oscar Health utilise des algorithmes de personnalisation axés sur l'IA qui génèrent 3,6 millions de recommandations de santé individuelles par an.

• Évaluations prédictives des risques pour la santé
• Suggestions de soins préventifs personnalisés
• Recommandations des voies de traitement personnalisées

Prix ​​d'assurance transparente et simplifiée

Les coûts mensuels du plan individuel mensuel moyen varient de 372 $ à 582 $, avec des limites maximales transparentes de 8 550 $ pour les particuliers et 17 100 $ pour les familles en 2024.

Services de télésanté à la demande

Oscar Health fournit des soins virtuels 24/7 avec 92% des consultations de télésanté résolues sans suivi en personne. Le temps de consultation virtuel moyen est de 12 minutes.

Performance de télésanté	2023 métriques
Taux d'achèvement de consultation virtuelle	92%
Durée de consultation moyenne	12 minutes

Outils de gestion de la santé numérique intégrés

L'écosystème numérique d'Oscar Health comprend l'intégration des appareils portables pour 680 000 utilisateurs actifs, avec 2,4 millions de points de données de santé suivis mensuellement.

• Suivi de santé en temps réel
• Informations sur la santé automatisée
• Écosystème de l'appareil connecté

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: relations avec les clients

Application mobile et interface numérique

L'application mobile d'Oscar Health compte plus de 500 000 utilisateurs numériques actifs au quatrième trimestre 2023. L'application prend en charge la gestion de l'assurance maladie en temps réel avec une note d'utilisateurs de 4,2 / 5 sur les magasins d'applications.

Métriques de plate-forme numérique	Données de performance
Téléchargements d'applications mobiles	750,000
Utilisateurs actifs mensuels moyens	385,000
Taux de traitement des réclamations numériques	87%

Coaching de santé personnalisé

Oscar Health fournit un coaching de santé personnalisé par le biais de 125 professionnels de la santé dévoués.

• Durée moyenne du coaching: 45 minutes
• Sessions de coaching de santé numérique: 42 000 par an
• Taux de satisfaction des membres: 93%

Support client 24/7

Les canaux de support client incluent le téléphone, le courrier électronique et le chat numérique avec des temps de réponse en moyenne 7 minutes.

Canal de support	Volume de contact annuel
Support téléphonique	1,2 million
Chat numérique	680,000
Assistance par e-mail	320,000

Canaux de communication numériques directs

Oscar Health utilise des stratégies de communication numérique multicanaux atteignant 92% de la base des membres.

• Notifications SMS: 1,5 million
• Communications par e-mail: 2,3 millions par mois
• Messagerie intégrée: 890 000 interactions mensuelles

Surveillance et engagement proactifs de la santé

Suivi de santé numérique avancé avec 340 000 membres à l'aide d'outils de surveillance.

Outil de surveillance	Engagement des utilisateurs
Intégration de suivi du fitness	215 000 utilisateurs
Gestion des maladies chroniques	125 000 utilisateurs
Alertes de soins préventifs	98% de participation des membres

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: canaux

Application mobile

Au quatrième trimestre 2023, l'application mobile d'Oscar Health compte 230 000 utilisateurs mensuels actifs. L'application prend en charge 87% des interactions d'assurance utilisateur. Les statistiques de téléchargement affichent 425 000 installations totales d'applications sur les plates-formes iOS et Android.

Métrique de l'application mobile	Données spécifiques
Utilisateurs actifs mensuels	230,000
Installations totales d'applications	425,000
Prise en charge de l'interaction utilisateur	87%

Plate-forme Web

La plate-forme Web d'Oscar Health traite 62% des interactions des membres. Le trafic Web mensuel est en moyenne de 415 000 visiteurs uniques. La gestion des comptes en ligne couvre 93% des exigences des services aux membres.

Métrique de la plate-forme Web	Données spécifiques
Visiteurs uniques mensuels	415,000
Interactions des membres traitées	62%
Exigences de service couvertes	93%

Services de télémédecine

Oscar Health fournit des services de télémédecine avec 78 000 consultations virtuelles par mois. La durée moyenne de la consultation est de 12 minutes. 64% des interactions de télémédecine se résolvent sans intervention médicale supplémentaire en personne.

• Consultations virtuelles mensuelles: 78 000
• Durée moyenne de la consultation: 12 minutes
• Taux de résolution de consultation: 64%

Équipe de vente directe

Oscar Health maintient une équipe de vente de 340 représentants directs. Le coût moyen d'acquisition des clients est de 285 $. Le taux de conversion de l'équipe de vente s'élève à 22% pour les régimes d'assurance individuels et en petits groupes.

Métrique de l'équipe de vente	Données spécifiques
Représentants des ventes directes	340
Coût d'acquisition des clients	$285
Taux de conversion	22%

Marketing numérique et publicité en ligne

Oscar Health alloue 4,2 millions de dollars par mois au marketing numérique. La publicité en ligne atteint 3,1 millions de clients potentiels. Les taux de clics en moyenne de 2,7% sur les plates-formes numériques.

• Budget de marketing numérique mensuel: 4,2 millions de dollars
• Propose potentielle du client: 3,1 millions
• Taux de clics de publicité numérique: 2,7%

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: segments de clientèle

Demandeurs d'assurance maladie individuels

Au quatrième trimestre 2023, Oscar Health dessert environ 1,2 million de membres individuels dans 21 États. L'âge moyen des demandeurs d'assurance individuels a 38 ans.

Segment de clientèle	Total des membres	Âge moyen	Propagation géographique
Assurance maladie individuelle	1,200,000	38	21 États

Jeunes consommateurs avertis et technophiles

Oscar Health cible les milléniaux et les consommateurs de la génération Z, avec 62% de leurs utilisateurs numériques âgés de 25 à 44 ans.

• Téléchargements d'applications numériques: 500 000 en 2023
• Taux d'engagement mobile: 73%
• Âge de l'utilisateur numérique moyen: 32 ans

Petites et moyennes entreprises

Oscar Health dessert environ 15 000 clients commerciaux de petite à moyenne taille en 2024.

Segment d'entreprise	Total des clients	Taille moyenne de l'entreprise	Revenus de primes annuelles
Assurance maladie SMB	15,000	50-250 employés	245 millions de dollars

Professionnels indépendants

Oscar Health couvre environ 85 000 professionnels indépendants en 2024.

• Adhésion au pigiste: 85 000
• Prime mensuelle moyenne: 487 $
• Industries primaires: technologie, créatif, consultation

Personnes soucieuses de la santé

Oscar Health attire les consommateurs soucieux de leur santé grâce à des programmes de bien-être numériques.

Programme de bien-être	Participants actifs	Taux d'engagement	Amélioration moyenne de la santé
Suivi du bien-être numérique	350,000	65%	12% d'amélioration des mesures de santé

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: Structure des coûts

Développement et maintenance technologiques

Investissement technologique annuel: 87,3 millions de dollars en 2023

Catégorie de dépenses technologiques	Coût annuel
Développement de logiciels	42,1 millions de dollars
Infrastructure cloud	18,5 millions de dollars
Cybersécurité	12,7 millions de dollars
Maintenance de plate-forme numérique	14 millions de dollars

Dépenses de réseau de prestataires de soins de santé

Coûts de gestion du réseau total: 156,2 millions de dollars en 2023

• Création de création du fournisseur: 23,4 millions de dollars
• Négociations de contrat de réseau: 41,6 millions de dollars
• Gestion des relations avec les fournisseurs: 31,2 millions de dollars
• Coûts d'extension du réseau: 60 millions de dollars

Traitement et gestion des réclamations

Total des frais de traitement des réclamations: 112,5 millions de dollars en 2023

Composant de traitement des réclamations	Coût annuel
Technologie de traitement des réclamations	37,8 millions de dollars
Personnel d'arbitrage des réclamations	44,3 millions de dollars
Systèmes de détection de fraude	15,4 millions de dollars
Analyse des réclamations	15 millions de dollars

Marketing et acquisition de clients

Total des dépenses de marketing: 64,7 millions de dollars en 2023

• Publicité numérique: 22,3 millions de dollars
• Publicité médiatique traditionnelle: 15,6 millions de dollars
• Programmes de référence client: 8,9 millions de dollars
• Personnel des ventes et du marketing: 17,9 millions de dollars

Conformité réglementaire et opérations d'assurance

Coûts totaux de conformité et d'exploitation: 93,6 millions de dollars en 2023

Catégorie de dépenses de conformité	Coût annuel
Conseil juridique et réglementaire	35,2 millions de dollars
Technologie de conformité	24,5 millions de dollars
Licence et frais de réglementation	18,9 millions de dollars
Formation de la conformité	15 millions de dollars

Oscar Health, Inc. (OSCR) - Modèle d'entreprise: Strots de revenus

Primes d'assurance maladie

Au troisième trimestre 2023, Oscar Health a déclaré un chiffre d'affaires total de 713,4 millions de dollars. Les primes d'assurance maladie représentaient la principale source de revenus, avec environ 687,2 millions de dollars générés par les collections de primes.

Catégorie de revenus	Montant (Q3 2023)	Pourcentage du total des revenus
Primes d'assurance maladie	687,2 millions de dollars	96.3%

Frais de consultation de la télésanté

Oscar Health a généré environ 15,3 millions de dollars des services de consultation de télésanté en 2023.

Insistance des données et services d'analyse

Les services d'analyse en technologie d'Oscar Health ont généré environ 6,5 millions de dollars de revenus pour 2023.

Type de service d'analyse	Contribution des revenus
Insistance aux données sur les soins de santé	4,2 millions de dollars
Analytique prédictive	2,3 millions de dollars

Licence de plate-forme technologique

Les licences de plateforme technologique ont généré 3,7 millions de dollars de revenus pour la santé des Oscars en 2023.

Services de santé à valeur ajoutée

Des services de santé supplémentaires ont contribué 4,9 millions de dollars à la source de revenus d'Oscar Health en 2023.

• Programmes de gestion des maladies chroniques
• Coordination des soins personnalisés
• Services de soutien à la santé mentale

Service à valeur ajoutée	Contribution des revenus
Gestion des maladies chroniques	2,1 millions de dollars
Coordination des soins	1,8 million de dollars
Soutien à la santé mentale	1,0 million de dollars

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.