PREMIUMS EARNED | PREMIUMS EARNED Premium revenue includes direct policy premiums collected directly from members and from the Centers for Medicare & Medicaid Services ("CMS") as part of the Advanced Premium Tax Credit Program ("APTC") and Medicare Advantage programs, along with assumed premiums from the Company's reinsurance agreements. Premium revenue is adjusted for the estimated impact of the risk adjustment program required by CMS. Total premiums earned includes the effect of reinsurance premiums ceded as part of the Company's reinsurance agreements. Refer to Note 4 - Reinsurance for more information. Three Months Ended Six Months Ended June 30, 2021 June 30, 2020 June 30, 2021 June 30, 2020 (in thousands) Direct policy premiums $ 838,075 $ 580,445 $ 1,658,889 $ 1,152,456 Assumed premiums 3,185 — 5,596 — Direct and assumed premiums 841,260 580,445 1,664,485 1,152,456 Risk adjustment (117,333) (186,905) (330,459) (334,468) Premiums before ceded reinsurance 723,927 393,540 1,334,026 817,988 Reinsurance premiums ceded (195,768) (279,784) (437,330) (619,013) Total premiums earned $ 528,159 $ 113,756 $ 896,696 $ 198,975 The following table summarizes the amounts of direct policy premiums received directly from CMS as part of APTC and Medicare Advantage for the three and six months ended June 30, 2021 and 2020: Three Months Ended Six Months Ended June 30, 2021 June 30, 2020 June 30, 2021 June 30, 2020 (in thousands) APTC $ 591,345 $ 344,996 $ 1,143,688 $ 676,792 Medicare Advantage 10,379 4,319 19,503 8,145 Total paid by CMS $ 601,724 $ 349,315 $ 1,163,191 $ 684,937 REINSURANCE The Company has entered into quota share reinsurance agreements with reinsurers under which the reinsurer assumes an agreed percentage of the underlying policies being reinsured and shares all premiums and incurred claims accordingly. As of April 1, 2021, the Company is party to reinsurance agreements with one reinsurer. Under the 2021 agreements, all premiums and claims ceded under the Company's quota share arrangements are shared proportionally with the reinsurers. Under the 2020 agreements, premiums and claims ceded are shared proportionally with the reinsurers, up to a limit specified in each agreement. The limit was removed from the 2021 agreements effective as of January 1, 2021. As part of the 2020 and 2021 agreements, the Company receives ceding commissions, which are calculated based on a percentage of ceded premiums, and experience refunds (resulting from actual claims experience being lower than a specified threshold). The composition of total reinsurance premiums ceded and reinsurance premiums assumed, which are included as components of total premiums earned in the consolidated statement of operations, is as follows: Three Months Ended Six Months Ended June 30, 2021 June 30, 2020 June 30, 2021 June 30, 2020 (in thousands) Reinsurance premiums ceded, gross $ (239,253) $ (306,427) $ (504,040) $ (664,137) Experience refunds 43,485 26,643 66,710 45,124 Reinsurance premiums ceded (195,768) (279,784) (437,330) (619,013) Reinsurance premiums assumed 3,185 — 5,596 — Total reinsurance premiums ceded and assumed $ (192,583) $ (279,784) $ (431,734) $ (619,013) The Company records claims expense net of reinsurance recoveries. The following table reconciles the total claims expense to the net claims expense as presented in the consolidated statement of operations: Three Months Ended Six Months Ended June 30, 2021 June 30, 2020 June 30, 2021 June 30, 2020 (in thousands) Direct claims incurred $ 598,904 $ 246,109 $ 1,056,123 $ 591,617 Ceded reinsurance claims (181,333) (190,597) (372,281) (451,887) Assumed reinsurance claims 2,308 — 4,085 (2) Total claims incurred, net $ 419,879 $ 55,512 $ 687,927 $ 139,728 The Company records selling, general and administrative expenses net of ceding commissions. The following table reconciles total other insurance costs to the amount presented in the consolidated statement of operations: Three Months Ended Six Months Ended June 30, 2021 June 30, 2020 June 30, 2021 June 30, 2020 (in thousands) Other insurance costs, gross $ 115,256 $ 69,893 $ 214,399 $ 145,823 Ceding commissions (20,466) (30,249) (39,772) (65,275) Other insurance costs, net $ 94,790 $ 39,644 $ 174,627 $ 80,548 The Company records reinsurance recoverables as “balances due from reinsurance programs” within current assets on its consolidated balance sheets. The composition of the reinsurance recoverables balance is as follows: June 30, 2021 December 31, 2020 (in thousands) Ceded reinsurance claim recoverables $ 326,587 $ 435,331 Reinsurance ceding commissions 32,051 41,586 Experience refunds on reinsurance agreements 41,536 102,476 Balances due from reinsurance programs $ 400,174 $ 579,393 The Company regularly evaluates the financial condition of its reinsurers to minimize exposure to significant losses. A key credit quality indicator for reinsurance is the financial strength ratings issued by the credit rating agencies, which provide an independent opinion of a reinsurer’s ability to meet ongoing obligations to policyholders. As of June 30, 2021, the Company's reinsurer has financial strength ratings of AA- (S&P and Fitch) and Aa3 (Moody's). |