0000950170-21-000261 | 10-Q | XBRL Viewer

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Document and Entity Information - shares	3 Months Ended
Document and Entity Information - shares	Mar. 31, 2021	May 12, 2021
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2021
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
Current Fiscal Year End Date	--12-31
Entity Central Index Key	0001832466
Entity Registrant Name	ALIGNMENT HEALTHCARE, INC.
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	ALHC
Security Exchange Name	NASDAQ
Entity Current Reporting Status	No
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity File Number	001-40295
Entity Tax Identification Number	46-5596242
Entity Incorporation, State or Country Code	DE
Entity Address, Address Line One	1100 W. Town and Country Road
Entity Address, Address Line Two	Suite 1600
Entity Address, City or Town	Orange
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92868
City Area Code	844
Local Phone Number	310-2247
Document Quarterly Report	true
Document Transition Report	false
Entity Common Stock, Shares Outstanding		187,273,782

Condensed Consolidated Balance Sheets (Unaudited) - USD ($)
$ in Thousands

Mar. 31, 2021

Dec. 31, 2020

Current Assets:

Cash

$ 528,417

$ 207,311

^[1]

Accounts receivable (less allowance for credit losses of $8 at March 31, 2021 and $0 at December 31, 2020, respectively)

49,458

40,140

^[1]

Prepaid expenses and other current assets

26,773

17,225

^[1]

Total current assets

604,648

264,676

^[1]

Property and equipment, net

28,403

27,145

^[1]

Right of use asset, net

9,577

9,888

^[1]

Goodwill and intangible assets, net

34,563

34,645

^[1]

Restricted and other assets

2,153

2,148

^[1]

Total assets

679,344

338,502

^[1]

Current Liabilities:

Medical expenses payable

128,673

112,605

^[1]

Accounts payable and accrued expenses

19,639

15,675

^[1]

Accrued compensation

21,481

25,172

^[1]

Total current liabilities

169,793

153,452

^[1]

Long-term debt, net of debt issuance costs

145,734

144,168

^[1]

Long-term portion of lease liabilities

9,565

10,271

^[1]

Total liabilities

325,092

307,891

^[1]

Commitments and Contingencies (Note 12)

Stockholders' Equity:

Preferred stock, $.001 par value; 100,000,000 and 0 shares authorized as of March 31, 2021 and December 31, 2020 respectively; no shares issued and outstanding as of March 31, 2021 and December 31, 2020

Common stock, $.001 par value; 1,000,000,000 and 164,063,787 shares authorized as of March 31, 2021 and December 31, 2020 respectively; 187,273,782 and 164,063,787 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively

188

164

^[1]

Additional Paid in Capital

790,509

410,018

^[1]

Accumulated deficit

(436,445)

(379,571)

^[1]

Total stockholders' equity

354,252

30,611

^[1],[2]

Total liabilities and stockholders' equity

$ 679,344

$ 338,502

^[1]

[1]	(1) The condensed consolidated balance sheet as of December 31, 2020 was derived from the audited consolidated financial statements as of that date and was retroactively adjusted, including shares and per share amounts, as a result of the Reorganization. See Note 1 to the condensed consolidated financial statements for additional details.
[2]	(1) The consolidated balances as of December 31, 2019 and 2020 were derived from the audited consolidated financial statements as of that date and were retroactively adjusted, including shares and per share amounts, as a result of the Reorganization. See Note 1 to the consolidated financial statements for additional details.

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Statement Of Financial Position [Abstract]
Allowance for credit losses	$ 8	$ 0
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	100,000,000	0
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	1,000,000,000	164,063,787
Common stock, shares issued	187,273,782	164,063,787
Common stock, shares outstanding	187,273,782	164,063,787

Condensed Consolidated Statements of Operations (Unaudited) - USD ($)
$ in Thousands

3 Months Ended

Mar. 31, 2021

Mar. 31, 2020

Revenues:

Earned premiums

$ 267,000

$ 224,266

Other

367

Total revenues

$ 267,082

$ 224,633

Revenue, Product and Service [Extensible List]

us-gaap:FinancialServiceMember

Expenses:

Medical expenses

$ 251,095

$ 193,396

Selling, general, and administrative expenses

64,914

32,787

Depreciation and amortization

3,737

3,565

Total expenses

319,746

229,748

Loss from operations

(52,664)

(5,115)

Other expenses:

Interest expense

4,248

4,160

Other (income) expenses

(38)

797

Total other expenses

4,210

4,957

Loss before income taxes

(56,874)

(10,072)

Provision for income taxes

Net loss

$ (56,874)

$ (10,072)

Total weighted-average common shares outstanding - basic and diluted

^[1]

154,432,027

140,764,196

Net loss per unit - basic and diluted

$ (0.37)

$ (0.07)

[1]	(1) The weighted-average shares used in computing net loss per share, basic and diluted were retroactively adjusted as a result of the Reorganization. See Note 1 to the condensed consolidated financial statements for additional details.

Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($)
$ in Thousands

Total

Common Stock

Additional Paid-in Capital

Accumulated Deficit

Beginning Balance at Dec. 31, 2019

^[1]

$ (78,711)

$ 147

$ 277,787

$ (356,645)

Beginning Balance, Shares at Dec. 31, 2019

^[1]

147,157,801

Net loss

(10,072)

$ 0

(10,072)

Issuance of common stock, net of issuance costs

131,300

$ 17

131,283

Issuance of common stock, net of issuance costs, Shares

16,905,986

Equity-based compensation

326

$ 0

326

Equity repurchase

(516)

Ending Balance at Mar. 31, 2020

42,327

$ 164

408,880

(366,717)

Ending Balance, Shares at Mar. 31, 2020

164,063,787

Beginning Balance at Dec. 31, 2020

^[1]

$ 30,611

^[2]

$ 164

410,018

(379,571)

Beginning Balance, Shares at Dec. 31, 2020

164,063,787

^[1]

Net loss

$ (56,874)

$ 0

(56,874)

Issuance of common stock, net of issuance costs

361,601

$ 22

361,579

Issuance of common stock, net of issuance costs, Shares

21,700,000

Issuance of common stock to third-party business partners

6,480

$ 1

6,479

Issuance of common stock to third-party business partners, Shares

573,782

Issuance of common stock to stock appreication rights holders

11,510

$ 1

11,509

Issuance of common stock to stock appreication rights holders, Shares

936,213

Equity-based compensation

2,398

$ 0

2,398

Equity repurchase

(1,474)

Ending Balance at Mar. 31, 2021

$ 354,252

$ 188

$ 790,509

$ (436,445)

Ending Balance, Shares at Mar. 31, 2021

187,273,782

[1]	(1) The consolidated balances as of December 31, 2019 and 2020 were derived from the audited consolidated financial statements as of that date and were retroactively adjusted, including shares and per share amounts, as a result of the Reorganization. See Note 1 to the consolidated financial statements for additional details.
[2]	(1) The condensed consolidated balance sheet as of December 31, 2020 was derived from the audited consolidated financial statements as of that date and was retroactively adjusted, including shares and per share amounts, as a result of the Reorganization. See Note 1 to the condensed consolidated financial statements for additional details.

Condensed Consolidated Statements of Stockholders' Equity (Unaudited) (Parenthetical) - IPO - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Stock price (in dollars per share)	$ 18	$ 7.99
Common stock issuance costs	$ 28,999	$ 3,700

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Operating Activities:
Net loss	$ (56,874)	$ (10,072)
Adjustments to reconcile net loss to net cash provided in operating activities:
Provision for doubtful accounts	8	10
Depreciation and amortization	3,789	3,670
Amortization-debt issuance costs and investment discount	550	540
Payment-in-kind interest	1,015	982
Loss on disposal of property and equipment	0	860
Equity-based compensation and common stock payments	20,388	326
Non-cash lease expense	648	573
Changes in operating assets and liabilities:
Accounts receivable	(9,326)	(9,671)
Prepaid expenses and other current assets	(9,547)	(8,908)
Other assets	(6)	2
Medical expenses payable	16,069	(5,516)
Accounts payable and accrued expenses	(298)	6,544
Accrued compensation	(3,691)	(1,101)
Lease liabilities	(832)	(3,883)
Noncurrent liabilities	0	(3,941)
Net cash used in operating activities	(38,107)	(21,819)
Investing Activities:
Purchase of investments	(750)	(1,000)
Sale of investments	750	250
Acquisition of property and equipment	(4,446)	(3,085)
Proceeds from the sale of property and equipment	0	100
Net cash used in investing activities	(4,446)	(3,735)
Financing Activities:
Equity repurchase	(1,474)	(516)
Issuance of common stock	390,600	135,000
Common stock issuance costs	(25,467)	(3,000)
Net cash provided by financing activities	363,659	131,484
Net increase in cash	321,106	105,930
Cash and restricted cash at beginning of period	207,811	86,484
Cash and restricted cash at end of period	528,917	192,414
Supplemental disclosure of cash flow information:
Cash paid for interest	2,682	2,637
Supplemental non-cash investing and financing activities:
Acquisition of property in accounts payable	474	93
Common stock issuance costs included in accounts payable and accrued expenses	3,532	700
Reconciliation of cash, cash equivalents and restricted cash as shown in the statement of cash flows:
Cash	528,417	192,414
Restricted cash in restricted and other assets	500	0
Cash and restricted cash at end of period	$ 528,917	$ 192,414

Organization

3 Months Ended

Mar. 31, 2021

Organization Consolidation And Presentation Of Financial Statements [Abstract]

Organization

1. Organization

Alignment Healthcare, Inc. (collectively, “we” or “us” or “our” or the “Company”), formerly, Alignment Healthcare Holdings, LLC, is a next generation, consumer-centric health care platform that is purpose-built to provide seniors with high quality, affordable care with a vastly improved consumer experience. Enabled by our innovative technology and care delivery model, the Company focuses on improving outcomes in the Medicare Advantage sector.

The Company’s operations primarily consist of the following:



The Company owns Medicare Advantage Plans in the states of California, North Carolina and Nevada.



The Company coordinates and provides covered health care services, including professional, institutional, and ancillary services, to members enrolled in certain benefit plans of unaffiliated Medicare Advantage Health Maintenance Organizations (“HMO”) (collectively, “Third-Party Payors”). The Company’s contracts with two different Third-Party Payors terminated on December 31, 2020 and 2019, respectively. The Company continues to service the claims in runoff related to their respective agreements.

Reorganization

We historically operated as a Delaware limited liability company under the name Alignment Healthcare Holdings, LLC. On March 17, 2021, Alignment Healthcare Holdings, LLC converted to a Delaware corporation pursuant to a statutory conversion and we changed our name to Alignment Healthcare, Inc. for purposes of completing an initial public offering ("IPO") ("the Reorganization"). As part of the Reorganization, Alignment Healthcare Partners, LP ("the Parent"), the sole unitholder of Alignment Healthcare Holdings, LLC, exchanged its membership units for our common stock and became the sole holder of our shares of common stock. Prior to the closing of the IPO, the Parent merged with and into the Company with Alignment Healthcare, Inc. surviving the merger.

The membership units that were owned by the Parent prior to the Reorganization were converted to our common stock using an approximately 1 to 260 common stock split. All share and per share amounts in these condensed consolidated financial statements and related notes have been retroactively adjusted, where applicable, for all periods presented to give effect to the common stock split and exchange ratio applied in connection with the Reorganization. As a result, we reclassified the capital contributions associated with the issuance of the membership units to additional paid-in capital and common stock using a par value of $0.001 for all periods presented within the condensed consolidated financial statements.

Initial Public Offering

On March 25, 2021, our Registration Statement on Form S-1 for the initial public offering of 27,200,000 shares of common stock was declared effective by the Securities and Exchange Commission. Our common stock began trading on March 26, 2021 on the Nasdaq Global Select Market under the ticker symbol “ALHC."

On March 30, 2021, we completed an IPO through issuing and selling 21,700,000 shares of common stock and certain stockholders selling 5,500,000 shares of common stock, in each case at a price of $18.00 per share. On April 6, 2021, pursuant to a partial exercise of the underwriters' over-allotment option, certain selling stockholders sold an additional 3,314,216 shares of common stock at the IPO price. The Company did not receive any proceeds from the sale of shares of common stock by the selling stockholders in the IPO. We received proceeds of $361,601 after deducting underwriting discounts and commissions of $24,389 and deferred offering costs of $4,610. Deferred direct offering costs were capitalized and consisted of fees and expenses incurred in connection with the sale of our common stock in the IPO, including legal, accounting, printing and other offering related costs. Upon completion of the IPO, these deferred offering costs were reclassified from prepaid and other current assets to stockholders' equity and recorded against the net proceeds from the offering.

Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2021

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements and accompanying notes have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been omitted pursuant to such regulations. These financial statements have been prepared on a basis consistent with the accounting principles applied for the fiscal year ended December 31, 2020 as presented in the Company’s Form S-1, as amended, filed with the SEC. In the opinion of management, all adjustments (consisting of all normal and recurring adjustments) considered necessary for a fair presentation have been included. These condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and accompanying note thereto as of December 31, 2020.

The condensed consolidated financial statements include the accounts of the Company, our subsidiaries, and two immaterial variable interest entities in which we are the primary beneficiary. All intercompany transactions have been eliminated in consolidation.

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net loss for all periods presented.

Use of Estimates

The preparation of the condensed consolidated financial statements requires management to make estimates and judgments that affect the amounts reported in the condensed consolidated financial statements. Our significant estimates include, but are not limited to, the determination of medical expenses payable; the impact of risk adjustment provisions related to our Medicare contracts; collectability of receivables; right of use (“ROU”) assets and lease liabilities valuation; valuation of related impairment recognition of long-lived assets, including goodwill and intangible assets; equity-based compensation expense; and contingent liabilities. Estimates and judgments are based upon historical information and on various other assumptions that are believed to be reasonable under the circumstances. Actual results could differ materially from those estimates and the impact of any change in estimates is included in earnings in the period in which the estimate is adjusted.

Segments

We have determined that our chief executive officer is the chief operating decision maker (“CODM”). We operate and manage the business as one reporting and one operating segment, which is referred to as the Medicare Advantage segment. Factors used in determining the reportable segment include the nature of operating activities, our organizational and reporting structure, and the type of information reviewed by the CODM to allocate resources and evaluate financial performance. All of our assets are located in the United States.

Fair Value Measurements

Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Our current assets and current liabilities approximate fair value because of the short-term nature of these financial instruments. Financial instruments measured at fair value on a recurring basis were based upon a three-tier hierarchy as follows:

Level 1 - Quoted prices in active markets for identical assets or liabilities

Level 2 - Other inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the asset or liability

Level 3 - Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date

The fair value of cash was determined based on Level 1 inputs. The fair value of deposits of US Treasury bills and certificate of deposits, which were included in restricted and other assets in the condensed consolidated balance sheets, was determined based on Level 2 inputs. There were no assets or liabilities measured at fair value using Level 3 inputs for the three months ended March 31, 2021 and 2020. Our long-term debt was reported at carrying value.

Revenue and Accounts Receivable

Earned premium revenue consisted of premium revenue and capitation revenue as of March 31, 2021 and 2020:


	March 31, 2021		March 31, 2020
Premium	$	264,713	$	204,277
Capitation		2,287		19,989
	$	267,000	$	224,266

Premium revenue is derived monthly from the federal government based on our contract with the Centers for Medicare and Medicaid Services (“CMS”). In accordance with this arrangement, we assume the responsibility for the outcomes and the economic risk of funding our members’ health care, supplemental benefits and related administration costs. We recognize premium revenue in the month that members are entitled to receive health care services, and premiums collected in advance are deferred. The monthly reimbursement includes a fixed payment per member month (“PMPM”), which is adjusted based on certain risk factors derived from medical diagnoses for our members. The adjustments are estimated by projecting the ultimate annual premium and are recognized ratably during the year, with adjustments each period to reflect changes in the estimated ultimate premium. Premiums are also recorded net of estimated uncollectible amounts and retroactive membership adjustments.

Capitation revenue consists primarily of capitated fees for medical care services provided by us under arrangements with our Third-Party Payors. Under those arrangements, we receive a PMPM payment for a defined member population, and we are responsible for providing health care services to the member population over the contract period. We are solely responsible for the cost of health care services related to the member population and in some cases, we are financially responsible for the supplemental benefits provided by us to the members. We act as a principal in arranging for and controlling the services provided by our provider network and we are at risk for arranging and providing health care services.

The premium and capitation payments we receive monthly from CMS for our members are determined from our annual bid or similarly from Third-Party Payors under our capitation arrangement. These payments represent revenues for providing health care coverage, including Medicare Part D benefits. Under the Medicare Part D program, our members and the members of our Third-Party Payors receive standard drug benefits. We may also provide enhanced benefits at our own expense. We recognize premium or capitation revenue for providing this insurance coverage in the month that members are entitled to receive health care services and any premium or capitation collected in advance is deferred. Our CMS payment related to Medicare Part D is subject to risk sharing through the Medicare Part D risk corridor provisions.

Revenue Adjustments

Payments by CMS to health plans are determined via a competitive bidding process with CMS and are based upon the cost of care in a local market and the average utilization of services by the member enrolled. These payments are subject to periodic adjustments under CMS’ “risk adjustment model,” which compensates health plans based on the health severity and certain demographic factors of each individual member. Members diagnosed with certain conditions are paid at a higher monthly payment than members who are healthier. Under this risk adjustment model, CMS calculates the risk adjustment payment using diagnosis data from hospital inpatient, hospital outpatient, and physician treatment settings. The Company and health care providers collect, capture, and submit the necessary and available diagnosis data to CMS within prescribed deadlines. Both premium and capitation revenues (including Medicare Part D) are subject to adjustments under the risk adjustment model.

Throughout the year, we estimate risk adjustment payments based upon the diagnosis data submitted and expected to be submitted to CMS. Those estimated risk adjustment payments are recorded as an adjustment to premium and capitation revenue. Our risk adjustment data is also subject to review by the government, including audit by regulators.

Our recognized premium revenue for our Medicare Advantage Plans in California, North Carolina and Nevada are each subject to a minimum annual medical loss ratio (“MLR”) of 85%. The MLR represents medical costs as a percentage of premium revenue. The Code of Federal Regulations define what constitutes medical costs and premium revenue, including certain additional expenses related to improving the quality of care provided, and to exclude certain taxes and fees, in each case as permitted or required by CMS and applicable regulatory requirements. If the minimum MLR is not met, we are required to remit a portion of the premiums back to the federal government. The amount remitted, if any, is recognized as an adjustment to premium revenues in the condensed consolidated statements of operations. There were no amounts payable for the MLR as of March 31, 2021 and December 31, 2020, respectively.

Medicare Part D payments are also subject to a federal risk corridor program, which limits a health plan’s overall losses or profit if actual spending for basic Medicare Part D benefits is much higher or lower than what was anticipated. Risk corridor is recorded within

premium revenue. The risk corridor provisions compare costs targeted in our bids or Third-Party Payors’ bids to actual prescription drug costs, limited to actual costs that would have been incurred under the standard coverage as defined by CMS. Variances exceeding certain thresholds may result in CMS or Third-Party Payors making additional payments to us or require us to refund a portion of the premiums we received. We estimate and recognize an adjustment to premiums revenue related to these provisions based upon pharmacy claims experience. We record a receivable or payable at the contract level and classify the amount as current or long-term in our condensed consolidated balance sheet based on the timing of expected settlement.

Receivables, including risk adjusted premium due from the government or through Third-Party Payors, pharmacy rebates, and other receivables, are shown net of allowances for credit losses and retroactive membership adjustments.

Property and Equipment—Net

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description		Estimated Service Lives (years)
Computer and equipment		5
Office equipment and furniture		5-7
Software		3-5
Leasehold improvements		15 (or lease term, if shorter)

Depreciation expense related to property and equipment used to service our members or at our clinics are included within medical expenses in the condensed consolidated statements of operations.

Medical Expenses and Medical Expense Payable

Medical expense includes claim payments, capitation payments, pharmacy costs net of rebates, allocations of certain centralized expenses, internal care delivery expenses and various other costs incurred to provide health insurance coverage and care to members, as well as estimates of future payments to hospitals and others for medical care and other supplemental benefits provided.

We have contracts with a network of hospitals, physicians, and other providers and compensates those providers and ancillary organizations based on contractual arrangements or CMS Medicare compensation guidelines. We pay these contracting providers either through fee-for-service arrangement in which the provider is paid negotiated rates for specific services provided or a capitation payment, which represent monthly contractual fees disbursed for each member regardless of medical services provided to the member. We are responsible for the entirety of the cost of health care services related to the member population, in addition to supplemental benefits provided by us to our seniors.

Capitation-related expenses are recorded on an accrual basis during the coverage period. Expenses related to fee-for-service contracts are recorded in the period in which the related services are dispensed.

Pharmacy costs represent payments for members’ prescription drug benefits, net of rebates from drug manufacturers. Receivables for such pharmacy rebates are included in accounts receivable in the condensed consolidated balance sheet.

Medical Expenses Payable

Medical expenses payable includes estimates of our obligations for medical care services that have been rendered on behalf of our members and the members of the Third-Party Payors, but for which claims have either not yet been received or processed, loss adjustment expense reserve for the expected costs of settling these claims, and for liabilities related to physician, hospital, and other medical cost disputes.

We develop estimates for medical expenses incurred but not yet paid (“IBNP”) using an actuarial process that is consistently applied and centrally controlled. Medical expenses payable includes claims reported but not yet paid, estimates for claims incurred but not reported, and estimates for the costs necessary to process unpaid claims at the end of each period. We estimate our medical claims liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors, such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of health care services, and other relevant factors. Each period, we re-examine previously established medical expense payable estimates based on actual claim submissions and other changes in facts and circumstances. As the medical expenses payable estimates recorded in prior periods develop, we adjust the amount of the estimates and include the changes in estimates in medical expenses in the period in which the change is identified.

Actuarial Standards of Practice generally require that the medical claims liability estimates be adequate to cover obligations under moderately adverse conditions. Moderately adverse conditions are situations in which the actual claims are expected to be higher than the otherwise estimated value of such claims at the time of estimate. In many situations, the claims amount ultimately settled will be different than the estimate that satisfies the Actuarial Standards of Practice. We include in our IBNP an estimate for medical claims liability under moderately adverse conditions, which represents the risk of adverse deviation of the estimates in our actuarial method of reserving. We believe that medical expenses payable is adequate to cover future claims payments required. However, such estimates are based on knowledge of current events and anticipated future events. Therefore, the actual liability could differ materially from the amounts provided.

We reassess the profitability of contracts for providing coverage to members when current operating results or forecasts indicate probable future losses. A premium deficiency reserve is established in current operations to the extent that the sum of expected future costs, claim adjustment expenses, and maintenance costs exceed related future premiums under contracts without consideration of investment income. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with the method of acquiring, servicing, and measuring the profitability of such contracts. Losses recognized as a premium deficiency result in a beneficial effect in subsequent periods as operating losses under these contracts are charged to the liability previously established.

Part D Subsidies

We also receive advance payments each month from CMS related to Catastrophic Reinsurance, Coverage Gap Discount, and the Low-Income Member Cost Sharing Subsidy (“Subsidies”). Reinsurance subsidies represent funding from CMS for our portion of prescription drug costs, which exceed the member’s out-of-pocket threshold or the catastrophic coverage level. Low-income cost subsidies represent funding from CMS for all or a portion of the deductible, the coinsurance and co-payment amounts above the out-of-pocket threshold for low-income beneficiaries. Additionally, the Health Care Reform Law mandates consumer discounts of 75% on brand-name prescription drugs for Part D plan participants in the coverage gap. The majority of the discounts are funded by the pharmaceutical manufacturers, while we fund a smaller portion and administer the application of the total discount. These Subsidies represent cost reimbursements under the Medicare Part D program and are recorded as deposits.

These Subsidies received in excess of, or less than, actual subsidized benefits paid are refundable to or recoverable from CMS through an annual reconciliation process following the end of the contract year.

Shared Risk Reserve Arrangements

We established a fund (also referred to as “a pool”) for risk and profit-sharing with various independent physician associations (“IPAs”). The pool enables us and our IPAs to share in the financial responsibility and/or upside associated with providing covered medical expenses to our members. The risk pool is based on a contractually agreed upon medical budget, typically based upon a percentage of revenue. If actual medical expenses are less than the budgeted amount, this results in a surplus. Conversely, if actual medical expenses are greater than the budgeted amount, this results in a deficit. We will distribute the surplus, or a portion thereof, to each IPA based upon contractual terms. Deficits are charged to shared risk providers’ risk pool as per the contractual term and evaluated for collectability at each reporting period.

We record risk-sharing receivables and payables on a gross basis on the condensed consolidated balance sheet. Throughout the year, we evaluate expected losses on risk-sharing receivables and record the resulting expected losses to the reserve. We systematically build and release reserves based on adequacy and its assessment of expected losses on a monthly basis. Credit loss associated with risk share deficit receivables are recorded within medical expense in the condensed consolidated statements of operations. As of March 31, 2021 and December 31, 2020, we recorded a valuation allowance for substantially all of the risk-sharing receivable balance due to collection risk related to the balance. The risk-sharing payable is included within medical expenses payable on the condensed consolidated balance sheet.

Concentrations of Credit Risk

Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash deposits and restricted investments with financial institutions. Accounts at each financial institution are insured by the Federal Deposit Insurance Corporation (“FDIC”) up to certain limits. At March 31, 2021 and December 31, 2020, there was $525,983 and $205,882, respectively in excess of FDIC-insured limits.

Industry Tax

Section 9010 of the Patient Protection and Affordable Care Act imposes an annual, nondeductible insurance industry tax (“Industry Tax”), which is levied proportionately across the insurance industry for risk-based products. The Industry Tax was estimated

based on a ratio of our net premiums written compared to the US Health insurance total net premiums. The Industry Tax was $3,343 for the three months ended March 31, 2020 and was reported as selling, general and administrative expenses. The Industry Tax has been repealed for calendar years beginning after December 31, 2020.

Equity-Based Compensation

Equity-based compensation expense is measured and recognized based on the grant date fair value of the awards. The grant date fair value of stock options is estimated using the Black-Scholes option pricing model. The grant date fair value of Restricted Stock Units (“RSUs”) and Restricted Stock Awards (“RSAs”) is estimated based on the fair value of our underlying common stock.

The Black-Scholes option pricing model requires the use of highly subjective assumptions, including the award’s expected term, the fair value of the underlying common stock, the expected volatility of the price of the common stock, risk-free interest rates, and the expected dividend yield of the common stock. The assumptions used to determine the fair value of the stock-based awards are management’s best estimates and involve inherent uncertainties and the application of judgment. The expected term represents the period the stock-based awards are expected to be outstanding. As we do not have sufficient historical experience for determining the expected term of the stock option awards granted, it was on the simplified method available under U.S. GAAP. As we do not have trading history, volatility assumptions were developed using the historical volatilities of a set of peer companies, adjusted for debt-equity leverage. Equity-based compensation expense for awards with service-based vesting only is recognized on a straight-line basis over the requisite service period of the awards, which is generally four years. We account for forfeitures as they occur.

Additionally, prior to the IPO, the Parent had granted its Class B and Class C units to certain of our executives and board members ("Incentive Units") and had also approved the Company’s Stock Appreciation Rights (“SARs”) Plan. Upon the IPO, SARs were modified and concurrently were, partially settled in cash and partially settled with issuance of common stock, a portion of which is restricted as discussed in Note 10 below.

During March of 2021, we also amended certain of our contracts with third-party business partners and agreed to issue shares of common stock at the IPO price, in consideration for the discharge of certain contingent payment obligations under such agreements ("Stock Payment") as discussed in Note 10.

Equity-based compensation is recorded within selling, general and administrative expense, and medical expenses based on the function of the applicable employee and non-employee.

Net Loss per Share

The numerator for basic net loss per share is calculated as the net loss for the three months ended March 31, 2021 and 2020, respectively. The denominator for basic net loss per share is determined as the weighted-average number of unrestricted common shares outstanding during the period ended March 31, 2021 and 2020, respectively.

The following table sets forth the computation of basic and diluted net loss per share for the three months ended March 31, 2021 and 2020:


	March 31, 2021			March 31, 2020
Numerator:
Net loss attributable to common stockholders	$	(56,874	)	$	(10,072	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		165,611,120			152,916,985
Less: Restricted shares of common stock		11,179,093			12,152,789
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		154,432,027			140,764,196
Net loss per share:
Net loss per share - basic and diluted	$	(0.37	)	$	(0.07	)

Basic net loss per share is the same as diluted net loss per share as the inclusion of all potentially dilutive shares would have been anti-dilutive.

In addition to the restricted shares of common stock, we also excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share for the three months ended March 31, 2021 and 2020:


	March 31, 2021		March 31, 2020
Stock options		11,123,391		—
Restricted stock units		1,517,000		—
Total		12,640,391		—

Emerging Growth Company Status

We are an emerging growth company, as defined in the Jumpstart Our Business Startups Act of 2012 (the “JOBS Act”). Under the JOBS Act, emerging growth companies can delay adopting new or revised accounting standards issued subsequent to the enactment of the JOBS Act until such time as those standards apply to private companies. We elected to use this extended transition period for complying with new or revised accounting standards that have different effective dates for public and private companies until the earlier of the date that it (i) is no longer an emerging growth company or (ii) affirmatively and irrevocably opts out of the extended transition period provided in the JOBS Act. As a result, these condensed consolidated financial statements may not be comparable to companies that comply with the new or revised accounting pronouncements as of public company effective dates.

As described in “Recent Accounting Pronouncements Adopted” and “Recent Accounting Pronouncements Not Yet Adopted” below, we early adopted certain accounting standards, as the JOBS Act does not preclude an emerging growth company from adopting a new or revised accounting standard earlier than the time that such standard applies to private companies. We expect to use the extended transition period for any other new or revised accounting standards during the period in which it remains an emerging growth company.

Recent Accounting Pronouncements Adopted

On January 2021, we early adopted Accounting Standards Update (“ASU”) No. 2017-04, Simplifying the Test for Goodwill Impairment. This ASU eliminates the requirement to calculate the implied fair value of goodwill to measure a goodwill impairment charge. A goodwill impairment charge would be recognized if the carrying amount of a reporting unit exceeds the estimated fair value of the reporting unit. This guidance did not have a material impact to our condensed consolidated financial statements.

On January1, 2021, we adopted ASU No. 2018-17, Targeted Improvements to Related Party Guidance for Variable Interest Entities, which provides clarification on determining whether a decision-making fee is a variable interest. This ASU requires reporting entities to consider indirect interests held through related parties under common control on a proportional basis rather than as the equivalent of a direct interest in its entirety. This guidance did not have a material impact to our condensed consolidated financial statements.

On January1, 2021, we adopted ASU No. 2018-15, Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract, which aligns the requirements for capitalization implementation costs incurred in a hosting arrangement that is a service contract with the requirement for capitalizing implementation costs incurred to develop or obtain internal-use software. Capitalized implementation costs related to a hosting arrangement that is a service contract will be amortized over the term of the hosting arrangement. New disclosures are required. This guidance did not have a material impact to our condensed consolidated financial statements.

Fair Value

3 Months Ended

Mar. 31, 2021

Fair Value Disclosures [Abstract]

Fair Value

3. Fair Value

US Treasury bills and certificate of deposits are reported at amortized costs which is equivalent to fair value. The following tables present the carrying value and fair value of these financial instruments as of March 31, 2021 and December 31, 2020:


	March 31, 2021
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
US Treasury bills	$	325	$	—	$	325	$	—
Certificate of deposits		1,116		—		1,116		—
Total	$	1,441	$	—	$	1,441	$	—


	December 31, 2020
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
US Treasury bills	$	325	$	—	$	325	$	—
Certificate of deposits		1,115		—		1,115		—
Total	$	1,440	$	—	$	1,440	$	—

The carrying value of long-term debt represents the outstanding balance, net of unamortized debt issuance costs. As of March 31, 2021, the carrying value and fair value of our long-term debt was $145,734 and $150,754, respectively. As of December 31, 2020 the carrying value and fair value of our long-term debt was $144,168 and $149,965, respectively.

The fair value of our long-term debt is classified as a Level 3 financial instrument because certain inputs used to determine its fair value are not observable. The fair value was estimated using a discounted cash flow (“DCF”) methodology. The discount rate used in the DCF model was estimated based on a synthetic credit rating analysis for us, and a screening of market data to identify market yields of instruments within the range of identified credit ratings and with otherwise similar features.

Our nonfinancial assets and liabilities, which include goodwill, intangible assets, property, and equipment, are not required to be measured at fair value on a recurring basis. However, on a periodic basis, or whenever events or changes in circumstances indicate that their carrying value may not be recoverable, we assess these assets for impairment. No such impairment resulted during the three months ended March 31, 2021 and 2020.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Accounts Receivable

3 Months Ended

Mar. 31, 2021

Accounts Receivable Net [Abstract]

Accounts Receivable

4. Accounts Receivable

Accounts receivable consisted of the following as of March 31, 2021 and December 31, 2020:


	March 31, 2021			December 31, 2020
Government receivables	$	18,828		$	10,392
Pharmacy rebates		28,512			25,888
Other receivables		2,126			3,860
Total accounts receivable		49,466			40,140
Allowance for credit losses		(8	)		—
Accounts receivable, net	$	49,458		$	40,140

The allowance for expected credit losses for accounts receivable is based primarily on past collections experience relative to the length of time receivables are past due. However, when available evidence reasonably supports an assumption that future economic conditions will differ from current and historical payment collections, an adjustment is reflected in the allowance for expected credit losses. We record pharmacy rebates and other receivables based on contractual terms and expected collections and our estimation process for contractual allowances for such balances generally results in an allowance for balances outstanding greater than 90 days or if expected credit risks are known.

Receivables and any associated allowance are written off only when all collection attempts have failed and such amounts are determined unrecoverable. We regularly review the adequacy of these allowances based on a variety of factors, including age of the outstanding receivable and collection history. When circumstances related to specific collection patterns change, estimates of the recoverability of receivables are adjusted. Because substantially all of our receivable amounts are readily determinable and a large portion of our creditors are governmental authorities, our allowance for credit losses is insignificant.

We recorded credit loss related to accounts receivable of $8 and $10 during the three months ended March 31, 2021 and 2020, respectively. The amount was recorded in selling general, and administrative expense in the condensed consolidated statements of operations.

Property and Equipment

3 Months Ended

Mar. 31, 2021

Property Plant And Equipment [Abstract]

Property and Equipment

5. Property and Equipment

Property and equipment consisted of the following as of March 31, 2021 and December 31, 2020:


	March 31, 2021			December 31, 2020
Computers and equipment	$	8,608		$	8,309
Office equipment and furniture		4,380			4,363
Software		84,168			79,204
Leasehold improvements		6,116			6,083
Construction in progress		1,500			1,893
Subtotal		104,772			99,852
Less accumulated depreciation		(76,369	)		(72,707	)
Property and equipment-net	$	28,403		$	27,145

Depreciation expense for the three months ended March 31, 2021, was $3,707, of which $52 was included in medical expenses. Depreciation expense for the three months ended March 31, 2020, was $3,588, of which $105 was included in medical expenses.

Goodwill and Intangible Assets

3 Months Ended

Mar. 31, 2021

Goodwill And Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

6. Goodwill and Intangible Assets

Intangible assets consisted of the following as of March 31, 2021 and December 31, 2020:


	March 31, 2021
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	29,303	$	—	$	29,303	—
License (indefinite lived)		4,500		—		4,500	—
Plan member relationships		2,700		2,103		597	9 years
Other		633		470		163	2 - 10 years
	$	37,136	$	2,573	$	34,563


	December 31, 2020
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	29,303	$	—	$	29,303	—
License (indefinite lived)		4,500		—		4,500	—
Plan member relationships		2,700		2,034		666	9 years
Other		633		457		176	2 - 10 years
	$	37,136	$	2,491	$	34,645

Amortization expense relating to intangible assets for the three months ended March 31, 2021 and 2020, was $82. Estimated amortization expense relating to intangible assets for each of the next five years ending December 31, is as follows:


Remainder of 2021	$	245
2022		327
2023		166
2024		22
Thereafter		—
	$	760

There were no impairment charges related to goodwill and intangible assets for the three months ended March 31, 2021 and 2020.

Medical Expenses Payable

3 Months Ended

Mar. 31, 2021

Insurance [Abstract]

Medical Expenses Payable

7. Medical Expenses Payable

The following table is a detail of medical expenses payable at March 31, 2021 and December 31, 2020:


	March 31, 2021		December 31, 2020
Claims incurred but not paid	$	81,337	$	82,391
Capitation payable, risk-sharing payable, and other		47,336		30,214
	$	128,673	$	112,605

Each period, we re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. As more complete claim information becomes available, we adjust the amount of the estimates and include the changes in estimates in claim costs in the period in which the change is identified. Substantially, all of the total claims paid by us are known and settled within the first year from the date of service, and substantially, all remaining claim amounts are paid within a three-year period.

The following table presents components of the change in medical expenses payable as of March 31, 2021 and 2020:


	March 31, 2021			March 31, 2020
Claims incurred but not paid - beginning balance	$	82,391		$	83,939
Incurred related to:
Current year		83,223			70,693
Prior years		(3,745	)		(7,078	)
Total incurred, net of reinsurance		79,478			63,615
Payments related to:
Current year		22,746			25,825
Prior years		57,786			49,547
Total payments, net of reinsurance		80,532			75,372
Claims incurred but not paid - ending balance		81,337			72,182
Other medical expenses payable		47,336			28,447
Total medical expenses payable	$	128,673		$	100,629

In March 2020, the COVID-19 outbreak was declared a pandemic. The COVID-19 virus disproportionately impacts older adults, especially those with chronic illnesses, which describes many of the seniors we serve. For the three months ended March 31, 2021, we experienced higher claims costs due to COVID-19 related inpatient admissions in the first half of the quarter. The ultimate impact of COVID-19 to us and our financial condition is presently unknown and we continue to monitor the impact of COVID-19 on our claims reserve estimate.

We re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. We recognized an unfavorable prior year development, excluding provision for adverse deviation, of $400 in the three months ended March 31, 2021.

Long-Term Debt

3 Months Ended

Mar. 31, 2021

Debt Disclosure [Abstract]

Long-Term Debt

8. Long-Term Debt

Long-term debt is recorded at carrying value in the consolidated balance sheets. The carrying value of long-term debt outstanding, net of unamortized debt issuance costs, consisted of the following at March 31, 2021 and December 31, 2020:


	March 31, 2021			December 31, 2020
Long-term debt	$	150,931		$	149,915
Less unamortized debt issuance costs		(5,197	)		(5,747	)
Long-term debt-net of amortization		145,734			144,168
Less current portion of long-term debt		—			—
Long-term debt - net of current portion	$	145,734		$	144,168

As of March 31, 2021, the total long-term debt balance of $150,931 included the principal balance of $135,000, the initial commitment fee of $6,750, and the payment-in-kind interest on the principal balance of $9,035. The payment-in-kind interest on the principal balance is also subject to the commitment fee which was $146 as of March 31, 2021. This amount was also included in the long-term debt balance.

The term loan matures in June 2023, at which time the full balance of the term loan, including the commitment fee and the payment-in-kind balance, will be due.

In addition, the term loan includes financial covenants regarding the maintenance of minimum liquidity of $6,000 of operating cash, as defined, on a consolidated basis, at least $10,000 in its cash accounts on a daily basis and minimum consolidated revenue amounts. The term loan also contains certain nonfinancial covenants. As of March 31, 2021 and December 31, 2020, we were in compliance with all financial and nonfinancial covenants.

The term loan was entered into by our wholly owned subsidiary and is also guaranteed by certain of our wholly owned subsidiaries and collateralized by all unrestricted assets of our subsidiaries.

Income Taxes

3 Months Ended

Mar. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

9. Income Taxes

There was no income tax expense for the three months ended March 31, 2021 and 2020.

We have cumulative NOLs as of March 31, 2021 and December 31, 2020. Given the history of losses, and after consideration for the risk associated with estimates of future taxable income, we established a full valuation allowance against net deferred tax assets at March 31, 2021 and December 31, 2020. As a result of the Tax Cuts and Jobs Act (“TCJA”), the federal NOLs generated in 2018 through 2020 will be carried forward indefinitely and are limited to an 80% deduction of taxable income. The 80% limitation is not applicable to NOLs generated before 2018. An exception to the TCJA federal NOL modification applies to nonlife insurance companies (e.g., Alignment Health Plan Inc.). Alignment Health Plan Inc.’s NOL treatment is the same as those NOLs generated in tax years 2017 and prior.

Additionally, an “ownership change” as defined under Section 382 of the Internal Revenue Code, could potentially limit the ability to utilize certain tax attributes including the Company’s substantial NOLs. Ownership change is generally defined as any significant change in ownership of more than 50% of its stock over a three-year testing period. If, as a result of current or future transactions involving our common stock, we undergo cumulative ownership changes which exceed 50% over the testing period, our ability to utilize our NOL carryforwards would be subject to additional limitations under IRC Section 382. We continue to monitor changes in ownership with respect to these income tax provisions.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Equity-Based Compensation

3 Months Ended

Mar. 31, 2021

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Equity-Based Compensation

10. Equity-Based Compensation

2021 Equity Incentive Plan

In connection with the IPO, on March 25, 2021, our Board of Directors adopted the 2021 Equity Incentive Plan (the “2021 Plan”). Under the 2021 Plan, employees, consultants and directors of our company and our affiliates that perform services for us are eligible to receive awards. The 2021 Plan provides for the grant of incentive stock options (“ISOs”), non-statutory stock options (“NSOs”), stock appreciation rights, restricted shares, performance awards, other share-based awards (including restricted stock units) and other cash-based awards. ISOs may be granted only to employees, including officers. All other awards may be granted to employees, including officers, non-employee directors and consultants. The maximum number of shares available for issuance under the 2021 Plan may not exceed 20,744,444 shares (subject to a discretionary annual increase of up to 4% effective as of January 1 of each year for 10 years).

IPO-Equity Awards

Stock options

Stock options generally vest 25% annually over four years and generally expire 10 years from the date of the grant. The 2021 Plan provides that stock option grants will be made at no less than the estimated fair value of common stock at the date of the grant.

The following is a summary of the stock option transactions as of and for the period ended March 31, 2021:


	Stock Options Outstanding
(amounts in thousands, except shares and per share amount)	Shares Subject to Options Outstanding		Weighted- Average Exercise Price per Option		Weighted- Average Remaining Contractual Terms (in years)		Aggregate Intrinsic Value
Balances as of December 31, 2020		—	$	—		—	$	—
Options granted		11,123,391		18.00		—		—
Options exercised		—		—		—		—
Options forfeited / expired		—		—		—		—
Balances as of March 31, 2021		11,123,391	$	18.00		9.99	$	43,715
Vested		—	$	—		—	$	—
Exercisable as of March 31, 2021		—	$	—		—	$	—

Aggregate intrinsic value represents the difference between the exercise price of the option and the closing price of our common stock. The aggregate intrinsic value of options exercised for three months ended March 31, 2021 and 2020 were both $0. The fair value of options granted during three months ended March 31, 2021 and 2020 was $83,982 and $0, respectively.

The weighted-average assumptions used to determine the fair value of stock options granted during the periods presented were as follows:


	Three Months Ended March 31,
	2021			2020
Expected term (in years)(1)	6.25 years			N/A
Expected volatility(2)		41.7	%	N/A
Risk-free interest rate(3)		1.1	%	N/A
Dividend yield(4)		0.0	%	N/A

(1)

An estimated expected life of 6.25 years before exercise was used for new options granted post-IPO, based on the midpoint of the vesting date and the full contractual term (known as the simplified method), as these were newly granted options. We do not have sufficient history of exercise for similar awards.

(2)

The expected volatility for new options granted post-IPO was estimated based on the historical daily price changes of our peer companies’ common stock over the most recent period equal to the expected term of the option, adjusted for debt-equity leverage.

(3)

The risk-free interest rate for period equal to the expected term of the option was based on the rate of treasury securities with the same term as the option as of the grant date.

(4)

An expected dividend yield of 0% was used because we have not historically paid dividends.

Restricted Stock Awards

New restricted stock awards ("RSAs") granted generally vest 25% annually over four years. RSAs converted from Pre-IPO awards generally vest on the later of the fourth anniversary of the original vesting commencement date or 50% annually on the first and second anniversary of the IPO (see “Pre-IPO Equity” and "Modifications" sections below for details).

The following is a summary of RSA transactions for the three months ended March 31, 2021:


	Restricted Shares		Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2020		—	$	—
Converted		10,348,789		7.85
Granted		214,669		18.00
Vested		—		—
Unvested and outstanding as of March 31, 2021		10,563,458	$	8.05

Restricted Stock Units

Restricted stock units ("RSU") generally vest 25% annually over four years.

The following is a summary of RSU transactions for the three months ended March 31, 2021:


	Restricted Stock Units		Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2020		—	$	—
Granted		1,517,000		18.00
Vested		—		—
Unvested and outstanding as of March 31, 2021		1,517,000	$	18.00

Non-Employee Awards

During the quarter ended March 31, 2021, total payment of $10,328 under the Company’s Stock Payment arrangement, as discussed in Note 2, was settled upon our successful IPO in 573,782 shares of our common stock at $18 per share with 214,669 of such common stock restricted and vesting over of a performance period of four years. The unrecognized stock compensation related to these RSAs of $3,848 will be recognized on a straight line basis over the performance period of the award.

Pre-IPO equity

Our Parent issued Incentive Units to certain employees, board members, and advisors, which were profits interests issued in Class B and Class C units. As of the IPO, only the time-vesting portion of Class B Incentive Units were fully vested.

In 2014, Alignment Healthcare Holdings, LLC’s Board of Directors adopted a Stock Appreciation Rights Plan (“SARs Plan”), under which Alignment Healthcare Holdings, LLC had granted awards in the form of SARs to employees, officers, directors, consultants, and other service providers of the Company.

Stock Appreciation Rights

80% of each SAR award vests 25% annually over four years and only becomes payable to the extent vested upon a qualified change in control (“Time-vesting SARs”), while the remaining 20% vests concurrent to the change in control (“Performance-vesting SARs”). The IPO was not considered a change in control under the original terms of the SARs. We have the option to settle SARs in either cash or equity upon an IPO.

In conjunction with the IPO, on March 24, 2021, the Company modified the Performance-vesting SARs to be converted into RSAs which vest 50% annually on each of the first and second anniversaries of the IPO. Vested Time-vesting SARs were settled approximately 50% in cash and 50% in common stock. The conversion of SARs resulted in the issuance of 300,489 RSAs.

The following table is a summary of SARs transactions for the three months ended March 31, 2021:


	SARs
Balance as of December 31, 2020		179,925
Granted		—
Canceled		(11,800	)
Cash settlement or converted into common stock		(168,125	)
Unvested and outstanding as of March 31, 2021		—

Incentive Units

A portion of Incentive Units vest annually over four years (“Time-vesting Incentive Units”) and the remaining Incentive Units vest upon a change in control (“Performance-vesting Incentives Units”). The IPO was not considered a change in control under the original terms of the Incentive Units.

The following table summarizes the equity-based awards activity as if the Series B and C Incentive Units were converted to RSA and common stock at the earliest period presented:


	Equivalent Shares of RSA and Common Stock
Balance as of December 31, 2019		22,185,514
Granted		—
Canceled		(324,330	)
Redeemed		—
Balance as of March 31, 2020		21,861,184


	Equivalent Shares of RSA and Common Stock
Balance as of December 31, 2020		23,882,595
Granted		—
Canceled		—
Redeemed		(231,313	)
Converted into common stock		(13,602,982	)
Converted into unvested RSAs		(10,048,300	)
Balance as of March 31, 2021		—

The following table summarizes unvested equity-based awards activity as if the Series B and C Incentive Units were converted to restricted common stock at the earliest period presented:


	Equivalent Shares of Restricted Common Stock
Balance as of December 31, 2019		12,856,273
Granted		—
Vested		(1,988,819	)
Balance as of March 31, 2020		10,867,454


	Equivalent Shares of Restricted Common Stock
Balance as of December 31, 2020		11,805,828
Granted		—
Vested		(1,757,528	)
Converted into unvested RSAs		(10,048,300	)
Balance as of March 31, 2021		—

Modifications

In conjunction with the Reorganization, the conversion of the Incentive Units into our RSAs was made pursuant to antidilution provisions of the original awards which required the award holders to be kept whole. As a result, there was no incremental compensation cost associated with the conversion.

In conjunction with the IPO, the Company modified the Time-vesting Incentive Units to be converted into RSAs and subject to the same time-vesting conditions upon the IPO, and modified the Performance-vesting SARs and Performance-vesting Incentive Units to be converted into RSAs which vest upon the later of the fourth anniversary of the original vesting commencement date or 50% annually on the first and second anniversary of the IPO.

Historically, no equity-based compensation expense was recognized for the SARs or Performance-vesting Incentive Units as the change in control was not probable.

As a result of the conversion and modification, we determined that the RSAs converted from the Performance-vesting SARs and the Performance-vesting Incentive Units should be remeasured as of the date of the modification (March 25, 2021).

The RSAs converted from the SARs were previously classified as liabilities and subject to remeasurement at fair value each reporting period. After the modification the converted RSAs were classified as equity, and were measured using the IPO stock price which will be recognized over the remaining modified vesting periods.

Equity-Based Compensation Expense

We recognized equity-based compensation expense as follows:


	Three Months Ended March 31,
(amounts in thousands)	2021		2020
Cash settlement of SARs	$	11,399	$	—
Modification charge from performance-based Incentive Units and SARs		921		—
Other		19,467		326
Total equity-based compensation expense	$	31,787	$	326

Total equity-based compensation was presented on the statement of operations as follows:


	Three Months Ended March 31,
(amounts in thousands)	2021		2020
Selling, general and administrative expenses	$	25,221	$	326
Medical expenses		6,566		—
Total equity-based compensation expense	$	31,787	$	326

As of March 31, 2021, there was $198,304 in unrecognized compensation expense related to all non-vested awards (RSAs, options and RSUs) that will be recognized over the weighted-average period of 3.17 years.

Regulatory Requirements and Restricted Funds

3 Months Ended

Mar. 31, 2021

Regulated Operations [Abstract]

Regulatory Requirements and Restricted Funds

11. Regulatory Requirements and Restricted Funds

Our health plans or risk-bearing entities are required to maintain minimum capital requirements prescribed by various regulatory authorities in each of the states in which it operates.

Risk-Based Capital Regulatory

The National Association of Insurance Commissioners has adopted rules, which, if implemented by the states, set minimum capitalization requirements for insurance companies, HMOs, and other entities bearing risk for health care coverage. The requirements take the form of risk-based capital (“RBC”) rules, which may vary from state to state. Certain states in which our health plans or risk bearing entities operate in have adopted the RBC rules. Our health plans or risk-bearing entities were in compliance with the minimum capital requirements for all periods presented.

Tangible Net Equity

Our health plan in California is required to comply with the tangible net equity (“TNE”) requirements. The required amount is the larger of: (1) $1,000; (2) 2% of the first $150,000 of annualized premium revenue, plus 1% of annualized premium revenue in excess of $150,000; or (3) 8% of the first $150,000 of annualized health care expenditures, except for those paid on a capitated or managed hospital payment basis, plus 4% of the annualized health care expenditures in excess of $150,000, except those paid on a capitated or managed hospital payment basis, plus 4% of annualized hospital expenditures paid on a managed hospital payment basis. We were in compliance with the TNE requirement at for all periods presented.

We have the ability to provide additional capital to each of our health plans or risk-bearing entities when necessary to ensure that the RBC and TNE requirements are met.

Certain states regulate the payment of dividends, loans, or other cash transfers from our regulated subsidiaries to our non-regulated subsidiaries and parent company. Such payments may require approval by state regulatory authorities and are limited based on certain financial criteria, such as the entity’s level of statutory income and statutory capital and surplus, or the entity’s level of tangible net equity or net worth, amongst other measures. These regulations vary by state. We were in compliance with the RBC and TNE requirements as of March 31, 2021 and December 31, 2020.

Restricted Assets

Pursuant to the regulations governing our subsidiaries, we maintain certain deposits required by the government authorities in the form of certificate of deposits and Treasury bills as protection in the event of insolvency. The use of funds from these investments is limited as required by regulation in the various states in which we operate, or as needed in the event of insolvency. Therefore, these deposits are reported within restricted and other assets on the consolidated balance sheet.

We hold these assets until maturity, at which time these assets will renew or are invested in a similar type of investment instrument. As a result, we do not expect the value of these investments to decline significantly due to a sudden change in market interest rates. These investments are carried at amortized cost, which approximates fair value.

Commitments and Contingencies

3 Months Ended

Mar. 31, 2021

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

12. Commitments and Contingencies

Legal Proceedings

We record a liability and accrue the costs for a loss when an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings. While the liability and accrued costs reflect our best estimate, the actual amounts may materially be different.

We may be involved in various litigation matters in the ordinary course of business. In the opinion of management, the ultimate resolution of legal proceedings is not expected to have a material adverse effect on the consolidated financial statements. Amounts accrued for legal proceedings were not material as of March 31, 2021 and December 31, 2020.

Summary of Significant Accounting Policies (Policies)

3 Months Ended

Mar. 31, 2021

Accounting Policies [Abstract]

Basis of Presentation

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net loss for all periods presented.

Use of Estimates

Segments

Fair Value Measurements

Level 1 - Quoted prices in active markets for identical assets or liabilities

Level 2 - Other inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the asset or liability

Level 3 - Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date

Revenue and Accounts Receivable

Earned premium revenue consisted of premium revenue and capitation revenue as of March 31, 2021 and 2020:


	March 31, 2021		March 31, 2020
Premium	$	264,713	$	204,277
Capitation		2,287		19,989
	$	267,000	$	224,266

Revenue Adjustments

Property and Equipment—Net

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description		Estimated Service Lives (years)
Computer and equipment		5
Office equipment and furniture		5-7
Software		3-5
Leasehold improvements		15 (or lease term, if shorter)

Depreciation expense related to property and equipment used to service our members or at our clinics are included within medical expenses in the condensed consolidated statements of operations.

Medical Expenses and Medical Expense Payable

Medical Expenses Payable

Part D Subsidies

Shared Risk Reserve Arrangements

Concentrations of Credit Risk

Industry Tax

Equity-Based Compensation

Equity-based compensation is recorded within selling, general and administrative expense, and medical expenses based on the function of the applicable employee and non-employee.

Net Loss per Share

The following table sets forth the computation of basic and diluted net loss per share for the three months ended March 31, 2021 and 2020:


	March 31, 2021			March 31, 2020
Numerator:
Net loss attributable to common stockholders	$	(56,874	)	$	(10,072	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		165,611,120			152,916,985
Less: Restricted shares of common stock		11,179,093			12,152,789
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		154,432,027			140,764,196
Net loss per share:
Net loss per share - basic and diluted	$	(0.37	)	$	(0.07	)

Basic net loss per share is the same as diluted net loss per share as the inclusion of all potentially dilutive shares would have been anti-dilutive.


	March 31, 2021		March 31, 2020
Stock options		11,123,391		—
Restricted stock units		1,517,000		—
Total		12,640,391		—

Emerging Growth Company Status

Recent Accounting Pronouncements Adopted

Summary of Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2021

Accounting Policies [Abstract]

Schedule of Earned Revenue

Earned premium revenue consisted of premium revenue and capitation revenue as of March 31, 2021 and 2020:


	March 31, 2021		March 31, 2020
Premium	$	264,713	$	204,277
Capitation		2,287		19,989
	$	267,000	$	224,266

Schedule of Property and Equipment Estimated Useful Lives

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description		Estimated Service Lives (years)
Computer and equipment		5
Office equipment and furniture		5-7
Software		3-5
Leasehold improvements		15 (or lease term, if shorter)

Schedule of Computation of Basic and Diluted Net Loss Per Share

The following table sets forth the computation of basic and diluted net loss per share for the three months ended March 31, 2021 and 2020:


	March 31, 2021			March 31, 2020
Numerator:
Net loss attributable to common stockholders	$	(56,874	)	$	(10,072	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		165,611,120			152,916,985
Less: Restricted shares of common stock		11,179,093			12,152,789
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		154,432,027			140,764,196
Net loss per share:
Net loss per share - basic and diluted	$	(0.37	)	$	(0.07	)

Schedule of Computation of Diluted Net Loss Per Share


	March 31, 2021		March 31, 2020
Stock options		11,123,391		—
Restricted stock units		1,517,000		—
Total		12,640,391		—

Fair Value (Tables)

3 Months Ended

Mar. 31, 2021

Fair Value Disclosures [Abstract]

Schedule of Carrying Value and Fair Value of Financial Instruments


	March 31, 2021
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
US Treasury bills	$	325	$	—	$	325	$	—
Certificate of deposits		1,116		—		1,116		—
Total	$	1,441	$	—	$	1,441	$	—


	December 31, 2020
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
US Treasury bills	$	325	$	—	$	325	$	—
Certificate of deposits		1,115		—		1,115		—
Total	$	1,440	$	—	$	1,440	$	—

Accounts Receivable (Tables)

3 Months Ended

Mar. 31, 2021

Accounts Receivable Net [Abstract]

Schedule of Accounts Receivable

Accounts receivable consisted of the following as of March 31, 2021 and December 31, 2020:


	March 31, 2021			December 31, 2020
Government receivables	$	18,828		$	10,392
Pharmacy rebates		28,512			25,888
Other receivables		2,126			3,860
Total accounts receivable		49,466			40,140
Allowance for credit losses		(8	)		—
Accounts receivable, net	$	49,458		$	40,140

Property and Equipment (Tables)

3 Months Ended

Mar. 31, 2021

Property Plant And Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment consisted of the following as of March 31, 2021 and December 31, 2020:


	March 31, 2021			December 31, 2020
Computers and equipment	$	8,608		$	8,309
Office equipment and furniture		4,380			4,363
Software		84,168			79,204
Leasehold improvements		6,116			6,083
Construction in progress		1,500			1,893
Subtotal		104,772			99,852
Less accumulated depreciation		(76,369	)		(72,707	)
Property and equipment-net	$	28,403		$	27,145

Goodwill and Intangible Assets (Tables)

3 Months Ended

Mar. 31, 2021

Goodwill And Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets

Intangible assets consisted of the following as of March 31, 2021 and December 31, 2020:


	March 31, 2021
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	29,303	$	—	$	29,303	—
License (indefinite lived)		4,500		—		4,500	—
Plan member relationships		2,700		2,103		597	9 years
Other		633		470		163	2 - 10 years
	$	37,136	$	2,573	$	34,563


	December 31, 2020
	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Life
Goodwill	$	29,303	$	—	$	29,303	—
License (indefinite lived)		4,500		—		4,500	—
Plan member relationships		2,700		2,034		666	9 years
Other		633		457		176	2 - 10 years
	$	37,136	$	2,491	$	34,645

Schedule of Estimated Amortization Expense Related to Intangible Assets

Estimated amortization expense relating to intangible assets for each of the next five years ending December 31, is as follows:


Remainder of 2021	$	245
2022		327
2023		166
2024		22
Thereafter		—
	$	760

Medical Expenses Payable (Tables)

3 Months Ended

Mar. 31, 2021

Insurance [Abstract]

Schedule of Medical Expenses Payable

The following table is a detail of medical expenses payable at March 31, 2021 and December 31, 2020:


	March 31, 2021		December 31, 2020
Claims incurred but not paid	$	81,337	$	82,391
Capitation payable, risk-sharing payable, and other		47,336		30,214
	$	128,673	$	112,605

Components of Change in Medical Expenses Payable

The following table presents components of the change in medical expenses payable as of March 31, 2021 and 2020:


	March 31, 2021			March 31, 2020
Claims incurred but not paid - beginning balance	$	82,391		$	83,939
Incurred related to:
Current year		83,223			70,693
Prior years		(3,745	)		(7,078	)
Total incurred, net of reinsurance		79,478			63,615
Payments related to:
Current year		22,746			25,825
Prior years		57,786			49,547
Total payments, net of reinsurance		80,532			75,372
Claims incurred but not paid - ending balance		81,337			72,182
Other medical expenses payable		47,336			28,447
Total medical expenses payable	$	128,673		$	100,629

Long-Term Debt (Tables)

3 Months Ended

Mar. 31, 2021

Debt Disclosure [Abstract]

Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs


	March 31, 2021			December 31, 2020
Long-term debt	$	150,931		$	149,915
Less unamortized debt issuance costs		(5,197	)		(5,747	)
Long-term debt-net of amortization		145,734			144,168
Less current portion of long-term debt		—			—
Long-term debt - net of current portion	$	145,734		$	144,168

Equity-Based Compensation (Tables)

3 Months Ended

Mar. 31, 2021

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Schedule of Equity-Based Compensation Expense

We recognized equity-based compensation expense as follows:


	Three Months Ended March 31,
(amounts in thousands)	2021		2020
Cash settlement of SARs	$	11,399	$	—
Modification charge from performance-based Incentive Units and SARs		921		—
Other		19,467		326
Total equity-based compensation expense	$	31,787	$	326

Schedule of Equity-Based Compensation Expense of Operation

Total equity-based compensation was presented on the statement of operations as follows:


	Three Months Ended March 31,
(amounts in thousands)	2021		2020
Selling, general and administrative expenses	$	25,221	$	326
Medical expenses		6,566		—
Total equity-based compensation expense	$	31,787	$	326

Stock Options

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Summary of Stock Option Activity Transactions

The following is a summary of the stock option transactions as of and for the period ended March 31, 2021:


	Stock Options Outstanding
(amounts in thousands, except shares and per share amount)	Shares Subject to Options Outstanding		Weighted- Average Exercise Price per Option		Weighted- Average Remaining Contractual Terms (in years)		Aggregate Intrinsic Value
Balances as of December 31, 2020		—	$	—		—	$	—
Options granted		11,123,391		18.00		—		—
Options exercised		—		—		—		—
Options forfeited / expired		—		—		—		—
Balances as of March 31, 2021		11,123,391	$	18.00		9.99	$	43,715
Vested		—	$	—		—	$	—
Exercisable as of March 31, 2021		—	$	—		—	$	—

Schedule of Weighted-Average Assumptions Used to Determine the Fair value of Stock Options Granted

The weighted-average assumptions used to determine the fair value of stock options granted during the periods presented were as follows:


	Three Months Ended March 31,
	2021			2020
Expected term (in years)(1)	6.25 years			N/A
Expected volatility(2)		41.7	%	N/A
Risk-free interest rate(3)		1.1	%	N/A
Dividend yield(4)		0.0	%	N/A

(1)

(2)

(3)

The risk-free interest rate for period equal to the expected term of the option was based on the rate of treasury securities with the same term as the option as of the grant date.

(4)

An expected dividend yield of 0% was used because we have not historically paid dividends.

Restricted Stock Awards

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Summary of Restricted Stock Transactions

The following is a summary of RSA transactions for the three months ended March 31, 2021:


	Restricted Shares		Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2020		—	$	—
Converted		10,348,789		7.85
Granted		214,669		18.00
Vested		—		—
Unvested and outstanding as of March 31, 2021		10,563,458	$	8.05

Restricted Stock Units

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Summary of Restricted Stock Transactions

The following is a summary of RSU transactions for the three months ended March 31, 2021:


	Restricted Stock Units		Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2020		—	$	—
Granted		1,517,000		18.00
Vested		—		—
Unvested and outstanding as of March 31, 2021		1,517,000	$	18.00

Non-Employee Awards

Stock Appreciation Rights (SARs)

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Summary of Stock Appreciation Rights Transactions

The following table is a summary of SARs transactions for the three months ended March 31, 2021:


	SARs
Balance as of December 31, 2020		179,925
Granted		—
Canceled		(11,800	)
Cash settlement or converted into common stock		(168,125	)
Unvested and outstanding as of March 31, 2021		—

Series B and C

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Summary of Equity Based Awards Converted to RSA and Common Stock

The following table summarizes the equity-based awards activity as if the Series B and C Incentive Units were converted to RSA and common stock at the earliest period presented:


	Equivalent Shares of RSA and Common Stock
Balance as of December 31, 2019		22,185,514
Granted		—
Canceled		(324,330	)
Redeemed		—
Balance as of March 31, 2020		21,861,184


	Equivalent Shares of RSA and Common Stock
Balance as of December 31, 2020		23,882,595
Granted		—
Canceled		—
Redeemed		(231,313	)
Converted into common stock		(13,602,982	)
Converted into unvested RSAs		(10,048,300	)
Balance as of March 31, 2021		—

Summary of Unvested Equity Based Awards Converted to RSA and Common Stock

The following table summarizes unvested equity-based awards activity as if the Series B and C Incentive Units were converted to restricted common stock at the earliest period presented:


	Equivalent Shares of Restricted Common Stock
Balance as of December 31, 2019		12,856,273
Granted		—
Vested		(1,988,819	)
Balance as of March 31, 2020		10,867,454


	Equivalent Shares of Restricted Common Stock
Balance as of December 31, 2020		11,805,828
Granted		—
Vested		(1,757,528	)
Converted into unvested RSAs		(10,048,300	)
Balance as of March 31, 2021		—

Organization - Additional Information (Details) - USD ($)	May 17, 2021	Apr. 06, 2021	Mar. 30, 2021	Mar. 25, 2021	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020
Subsidiary Sale Of Stock [Line Items]
Common stock, par value					$ 0.001	$ 0.001
IPO
Subsidiary Sale Of Stock [Line Items]
Issuance of common stock, net of issuance costs, Shares			21,700,000	27,200,000
Common stock split	1 to 260 common stock split
Common stock, par value	$ 0.001				18
Number of shares sold (in shares)			5,500,000
Stock price (in dollars per share)			$ 18.00		$ 18		$ 7.99
Proceeds from sale of stock, net			$ 361,601,000
Underwriting discounts and commissions			24,389,000
Deferred offering costs			$ 4,610,000
Subsequent Event \| IPO
Subsidiary Sale Of Stock [Line Items]
Issuance of common stock, net of issuance costs, Shares		3,314,216
Proceeds from sale of stock, net		$ 0

Summary of Significant Accounting Policies - Additional Information (Details)	3 Months Ended		12 Months Ended
	Mar. 31, 2021 USD ($) Entity Segment	Mar. 31, 2020 USD ($)	Dec. 31, 2020 USD ($)
Accounting Policies [Line Items]
Number of consolidated variable interest entities \| Entity	2
Number of reporting segments \| Segment	1
Number of operating segments \| Segment	1
Assets, fair value disclosure	$ 1,441,000		$ 1,440,000
Federal deposit insurance corporation premium expense	$ 525,983,000		205,882,000
Industry tax		$ 3,343,000
Award requisite service period	4 years
Level 3
Accounting Policies [Line Items]
Assets, fair value disclosure	$ 0	0	0
Liabilities, fair value disclosure	0	$ 0
Medicare Advantage Plan
Accounting Policies [Line Items]
Minimum loss ratio amounts payable	$ 0		$ 0
Percentage of consumer discounts on brand name	75.00%
Medicare Advantage Plan \| Minimum
Accounting Policies [Line Items]
Loss ratio	85.00%

Summary of Significant Accounting Policies - Schedule of Earned Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Disaggregation of Revenue [Line Items]
Total revenues	$ 267,000	$ 224,266
Premium
Disaggregation of Revenue [Line Items]
Total revenues	264,713	204,277
Capitation
Disaggregation of Revenue [Line Items]
Total revenues	$ 2,287	$ 19,989

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Summary of Significant Accounting Policies - Schedule of Property and Equipment Estimated Useful Lives (Details)	3 Months Ended
	Mar. 31, 2021
Computer and equipment
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Office equipment and furniture \| Minimum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Office equipment and furniture \| Maximum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	7 years
Software \| Minimum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	3 years
Software \| Maximum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Leasehold improvements
Property Plant and Equipment [Line Items]
Estimated service lives (years)	15 (or lease term, if shorter)

Summary of Significant Accounting Policies - Schedule of Computation of Basic and Diluted Net Loss Per Share (Details) - USD ($)
$ / shares in Units, $ in Thousands

3 Months Ended

Mar. 31, 2021

Mar. 31, 2020

Numerator:

Net loss attributable to common stockholders

$ (56,874)

$ (10,072)

Denominator:

Total weighted-average common shares outstanding - basic and diluted

165,611,120

152,916,985

Less: Restricted shares of common stock

11,179,093

12,152,789

Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted

^[1]

154,432,027

140,764,196

Net loss per share:

Net loss per share - basic and diluted

$ (0.37)

$ (0.07)

[1]	(1) The weighted-average shares used in computing net loss per share, basic and diluted were retroactively adjusted as a result of the Reorganization. See Note 1 to the condensed consolidated financial statements for additional details.

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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+ Details

Summary of Significant Accounting Policies - Schedule of Computation of Dilured Net Loss Per Share (Details) - shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Weighted Average Number of Shares Outstanding, Diluted	12,640,391	0
Restricted Stock Units
Weighted Average Number of Shares Outstanding, Diluted	1,517,000	0
Stock Option
Weighted Average Number of Shares Outstanding, Diluted	11,123,391	0

Fair Value - Schedule of Carrying Value and Fair Value of Financial Instruments (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	$ 1,441	$ 1,440
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,441	1,440
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0	$ 0
US Treasury Bills
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	325	325
US Treasury Bills \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
US Treasury Bills \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	325	325
US Treasury Bills \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
Certificate of Deposits
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,116	1,115
Certificate of Deposits \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
Certificate of Deposits \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,116	1,115
Certificate of Deposits \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	$ 0	$ 0

Fair Value - Additional Information (Details) - USD ($)	3 Months Ended
Fair Value - Additional Information (Details) - USD ($)	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Fair Value Disclosures [Abstract]
Long term debt carrying value	$ 145,734,000		$ 144,168,000
Long-term debt fair value	150,754,000		$ 149,965,000
Asset Impairment Charges	$ 0	$ 0

Accounts Receivable - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Accounts Receivable Net [Abstract]
Government receivables	$ 18,828	$ 10,392
Pharmacy rebates	28,512	25,888
Other receivables	2,126	3,860
Total accounts receivable	49,466	40,140
Allowance for credit losses	(8)	0
Accounts receivable, net	$ 49,458	$ 40,140

Accounts Receivable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Accounts Receivable Net [Abstract]
Credit loss related to accounts receivable	$ 8	$ 10

Property and Equipment - Schedule of Property and Equipment (Details) - USD ($)
$ in Thousands

Mar. 31, 2021

Dec. 31, 2020

Property Plant and Equipment [Line Items]

Subtotal

$ 104,772

$ 99,852

Less accumulated depreciation

(76,369)

(72,707)

Property and equipment-net

28,403

27,145

^[1]

Computer and equipment

Property Plant and Equipment [Line Items]

Subtotal

8,608

8,309

Office equipment and furniture

Property Plant and Equipment [Line Items]

Subtotal

4,380

4,363

Software

Property Plant and Equipment [Line Items]

Subtotal

84,168

79,204

Leasehold improvements

Property Plant and Equipment [Line Items]

Subtotal

6,116

6,083

Construction in progress

Property Plant and Equipment [Line Items]

Subtotal

$ 1,500

$ 1,893

[1]

(1)

The condensed consolidated balance sheet as of December 31, 2020 was derived from the audited consolidated financial statements as of that date and was retroactively adjusted, including shares and per share amounts, as a result of the Reorganization. See Note 1 to the condensed consolidated financial statements for additional details.

Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Property Plant and Equipment [Line Items]
Depreciation expense	$ 3,707	$ 3,588
Medical Expenses
Property Plant and Equipment [Line Items]
Depreciation expense	$ 52	$ 105

Goodwill and Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2021	Dec. 31, 2020
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 37,136	$ 37,136
Accumulated Amortization	2,573	2,491
Net Carrying Value	$ 34,563	$ 34,645
Weighted Average Life
Goodwill, Gross Carrying Value	$ 29,303	$ 29,303
Goodwill, Accumulated Amortization	0	0
Goodwill, Net Carrying Value	29,303	29,303
License (indefinite lived)
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	4,500	4,500
Accumulated Amortization	0	0
Net Carrying Value	$ 4,500	$ 4,500
Weighted Average Life
Plan Member Relationship
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 2,700	$ 2,700
Accumulated Amortization	2,103	2,034
Net Carrying Value	$ 597	$ 666
Weighted Average Life	9 years	9 years
Other
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 633	$ 633
Accumulated Amortization	470	457
Net Carrying Value	$ 163	$ 176
Other \| Minimum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Weighted Average Life	2 years	2 years
Other \| Maximum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Weighted Average Life	10 years	10 years

Goodwill and Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Goodwill And Intangible Assets Disclosure [Abstract]
Amortization expense	$ 82	$ 82
Impairment charges	$ 0	$ 0

Goodwill and Intangible Assets - Schedule of Estimated Amortization Expense Related to Intangible Assets (Details) $ in Thousands	Mar. 31, 2021 USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
Remainder of 2021	$ 245
2022	327
2023	166
2024	22
Thereafter
Estimated amortization expense related to intangible assets	$ 760

Medical Expenses Payable - Schedule of Medical Expenses Payable (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2019
Insurance [Abstract]
Claims incurred but not paid	$ 81,337	$ 82,391	$ 72,182	$ 83,939
Capitation payable, risk-sharing payable, and other	47,336	30,214
Total medical expenses payable	$ 128,673	$ 112,605	$ 100,629

Medical Expenses Payable - Components of Change in Medical Expenses Payable (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Insurance [Abstract]
Claims incurred but not paid - beginning balance	$ 82,391	$ 83,939
Incurred related to:
Current year	83,223	70,693
Prior years	(3,745)	(7,078)
Total incurred, net of reinsurance	79,478	63,615
Payments related to:
Current year	22,746	25,825
Prior years	57,786	49,547
Total payments, net of reinsurance	80,532	75,372
Claims incurred but not paid - ending balance	81,337	72,182
Other medical expenses payable	47,336	28,447
Total medical expenses payable	$ 128,673	$ 100,629	$ 112,605

Medical Expenses Payable - Additional Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Insurance [Abstract]
Claims reserve estimates, excluding provision	$ 400
Remaining claim amounts payment period	3 years

Long-Term Debt - Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs (Details) - USD ($)
$ in Thousands

Mar. 31, 2021

Dec. 31, 2020

Debt Disclosure [Abstract]

Long-term debt

$ 150,931

$ 149,915

Less unamortized debt issuance costs

(5,197)

(5,747)

Long-term debt-net of amortization

145,734

144,168

Less current potion of long-term debt

Long-term debt - net of current portion

$ 145,734

$ 144,168

^[1]

[1]

(1)

Long-Term Debt - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Long-term debt	$ 150,931	$ 149,915
Long term debt	145,734	$ 144,168
Debt instrument principal outstanding	135,000
Commitment fee	6,750
Payment in kind interest on principal balance	9,035
Payment-in-kind interest on the principal balance, commitment fee.	$ 146
Term loan facility maturity date	Jun. 30, 2023
Term Loan
Debt Instrument [Line Items]
Minimum liquidity balance on operating cash	$ 6,000
Minimum liquidity balance on operating cash in cash account on daily basis	$ 10,000
Debt description	The term loan was entered into by our wholly owned subsidiary and is also guaranteed by certain of our wholly owned subsidiaries and collateralized by all unrestricted assets of our subsidiaries

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Operating Loss Carryforwards [Line Items]
Income tax expense	$ 0	$ 0
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Taxable income deduction limit percentage	80.00%

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Equity-Based Compensation - Additional Information (Details) - USD ($)
$ / shares in Units, $ in Thousands

3 Months Ended

Mar. 24, 2021

Mar. 31, 2021

Mar. 31, 2020

May 17, 2021

Dec. 31, 2020

Dec. 31, 2019

^[1]

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Aggregate intrinsic value, options exercised

$ 0

Options granted, fair value

83,982

Share based compensation expense

$ 31,787

326

Common Stock issued settled

187,273,782

164,063,787

Common stock, par value

$ 0.001

Stock Options

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Annual award vesting rights, percentage

25.00%

Award vesting period

4 years

Award expiration period

10 years

Restricted Stock Awards

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Annual award vesting rights, percentage

25.00%

Number of shares issued

300,489

Award vesting period

4 years

Share based compensation expense, unrecognized

$ 3,848

Pre-IPO Awards Converted RSAs

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Annual award vesting rights, percentage

50.00%

RSUs

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Annual award vesting rights, percentage

25.00%

Stock Appreciation Rights (SARs)

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Annual award vesting rights, percentage

50.00%

25.00%

Share based payment award, description and terms

Share based compensation expense

$ 11,399

$ 0

Non-vested awards RSAs, options and RSUs

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Share based compensation expense

10,328

Share based compensation expense, unrecognized

$ 198,304

Weighted average contractual term

3 years 2 months 1 day

2021 Equity Incentive Plan

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Number of shares available for issuance, annual percentage increase

4.00%

Number of share available for grant, annual percentage increase, term

10 years

2021 Equity Incentive Plan | Maximum

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Number of shares available for issuance

20,744,444

Cash | Stock Appreciation Rights (SARs)

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Award vesting rights settled, percentage

50.00%

Common Stock

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Common Stock issued settled

187,273,782

164,063,787

^[1]

147,157,801

Common Stock | Stock Appreciation Rights (SARs)

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Award vesting rights settled, percentage

50.00%

IPO

Share Based Compensation Arrangement by Share Based Payment Award [Line Items]

Common Stock issued settled

573,782

Common stock, par value

$ 18

$ 0.001

Settled of Common Stock restricted

214,669

[1]

(1)

The consolidated balances as of December 31, 2019 and 2020 were derived from the audited consolidated financial statements as of that date and were retroactively adjusted, including shares and per share amounts, as a result of the Reorganization. See Note 1 to the consolidated financial statements for additional details.

Equity-Based Compensation - Summary of Stock Option Activity Transactions (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Options outstanding, beginning balance	0
Options granted	11,123,391
Options exercised	0
Options forfeited / expired	0
Options outstanding, ending balance	11,123,391		0
Options outstanding, vested and expected to vest	0
Options outstanding, exercisable	0
Weighted-average exercise price per option, beginning balance	$ 18.00		$ 0
Weighted-average exercise price per option, options granted	18.00
Weighted-average exercise price per option, options exercised	0
Weighted-average exercise price per option, options forfeited / expired	0
Weighted-average exercise price per option, ending balance	18.00		$ 0
Weighted-average exercise price per option, vested and expected to vest	0
Weighted-average exercise price per option, exercisable	$ 0
Weighted-average remaining contractual terms, outstanding	9 years 11 months 26 days
Weighted-average remaining contractual terms, options granted
Weighted-average remaining contractual terms, options exercised
Weighted-average remaining contractual terms, options forfeited / expired
Weighted-average remaining contractual terms, vested and expected to vest
Weighted-average remaining contractual terms, exercisable
Aggregate intrinsic value, beginning balance	$ 0
Aggregate intrinsic value, options granted	0
Aggregate intrinsic value, options exercised	0	$ 0
Aggregate intrinsic value, options forfeited / expired	0
Aggregate intrinsic value, ending balance	43,715		$ 0
Aggregate intrinsic value, vested and expected to vest	0
Aggregate intrinsic value, exercisable	$ 0

Equity-Based Compensation - Schedule of Weighted-Average Assumptions Used to Determine the Fair Value of Stock Options Granted (Details) - Stock Options

3 Months Ended

Mar. 31, 2021

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Expected term (in years)

6 years 3 months

^[1]

Expected volatility

41.70%

^[2]

Risk-free interest rate

1.10%

^[3]

Dividend yield

0.00%

^[4]

[1]	(1) An estimated expected life of 6.25 years before exercise was used for new options granted post-IPO, based on the midpoint of the vesting date and the full contractual term (known as the simplified method), as these were newly granted options. We do not have sufficient history of exercise for similar awards.
[2]	(2) The expected volatility for new options granted post-IPO was estimated based on the historical daily price changes of our peer companies’ common stock over the most recent period equal to the expected term of the option, adjusted for debt-equity leverage.
[3]	(3) The risk-free interest rate for period equal to the expected term of the option was based on the rate of treasury securities with the same term as the option as of the grant date.
[4]	(4) An expected dividend yield of 0% was used because we have not historically paid dividends. Restricted Stock Awards

Equity-Based Compensation - Schedule of Weighted-Average Assumptions Used to Determine the Fair Value of Stock Options Granted (Parenthetical) (Details) - Stock Options

3 Months Ended

Mar. 31, 2021

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Expected life

6 years 3 months

^[1]

Dividend yield

0.00%

^[2]

Post IPO

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Expected life

6 years 3 months

[1]	(1) An estimated expected life of 6.25 years before exercise was used for new options granted post-IPO, based on the midpoint of the vesting date and the full contractual term (known as the simplified method), as these were newly granted options. We do not have sufficient history of exercise for similar awards.
[2]	(4) An expected dividend yield of 0% was used because we have not historically paid dividends. Restricted Stock Awards

Equity-Based Compensation - Summary of RSAs Transactions (Details) - Restricted Stock Awards	3 Months Ended
	Mar. 31, 2021 $ / shares shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unvested and outstanding, beginning balance \| shares	0
Converted \| shares	10,348,789
Granted \| shares	214,669
Vested \| shares	0
Unvested and outstanding, ending balance \| shares	10,563,458
Weighted-average grant date fair value, beginning balance \| $ / shares	$ 0
Weighted-average grant date fair value, converted \| $ / shares	7.85
Weighted-average grant date fair value, granted \| $ / shares	18.00
Weighted-average grant date fair value, vested \| $ / shares	0
Weighted-average grant date fair value, ending balance \| $ / shares	$ 8.05

Equity-Based Compensation - Summary of RSUs Transactions (Details) - Restricted Stock Units	3 Months Ended
	Mar. 31, 2021 $ / shares shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unvested and outstanding, beginning balance \| shares	0
Granted \| shares	1,517,000
Vested \| shares	0
Unvested and outstanding, ending balance \| shares	1,517,000
Weighted-average grant date fair value, beginning balance \| $ / shares	$ 0
Weighted-average grant date fair value, granted \| $ / shares	18.00
Weighted-average grant date fair value, vested \| $ / shares	0
Weighted-average grant date fair value, ending balance \| $ / shares	$ 18.00

Equity-Based Compensation - Schedule of Stock Appreciation Rights Transactions (Details)	3 Months Ended
	Mar. 31, 2021 shares
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Options outstanding, beginning balance	0
Granted	11,123,391
Options outstanding, ending balance	11,123,391
Stock Appreciation Rights (SARs)
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Options outstanding, beginning balance	179,925
Granted	0
Canceled	(11,800)
Cash settlement or converted into common stock	(168,125)
Options outstanding, ending balance	0

Equity-Based Compensation - Equity Based Awards Converted to RSA and Common Stock (Details) - shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Beginning Balance	0
Redeemed		0
Options outstanding, vested and expected to vest	0
Series B and C
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Beginning Balance	0	21,861,184	23,882,595	22,185,514
Granted	0	0
Canceled	0	(324,330)
Redeemed	(231,313)
Converted into common stock	(13,602,982)
Converted into unvested RSAs	(10,048,300)
Options outstanding, vested and expected to vest	0	21,861,184	23,882,595	22,185,514

Equity-Based Compensation - Summary Of Unvested Equity Based Awards Converted To RSA And Common Stock (Details) - Series B and C - shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Unvested and outstanding, beginning balance	11,805,828	12,856,273
Granted	0	0
Vested	(1,757,528)	(1,988,819)
Converted into unvested RSAs	(10,048,300)
Unvested and outstanding, ending balance	0	10,867,454

Equity-Based Compensation - Schedule of Equity-Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 31,787	$ 326
Cash Settlement of SARs
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	11,399	0
Modification Charge from Performance Based Incentive Units and SARs
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	921	0
Other
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 19,467	$ 326

Equity-Based Compensation - Schedule of Equity-based Compensation Expense on Statement of Operations (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 31,787	$ 326
Selling, General and Administrative Expenses
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	25,221	326
Medical Expenses
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 6,566	$ 0

Regulatory Requirements and Restricted Funds - Additional Information (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Regulated Operations [Abstract]
Disclosure of Tangible net equity requirement	The required amount is the larger of: (1) $1,000; (2) 2% of the first $150,000 of annualized premium revenue, plus 1% of annualized premium revenue in excess of $150,000; or (3) 8% of the first $150,000 of annualized health care expenditures, except for those paid on a capitated or managed hospital payment basis, plus 4% of the annualized health care expenditures in excess of $150,000, except those paid on a capitated or managed hospital payment basis, plus 4% of annualized hospital expenditures paid on a managed hospital payment basis. We were in compliance with the TNE requirement at for all periods presented.
Tangible net equity, required amount	$ 1,000
Annualized premium revenue, percentage	2.00%
Annualized premium revenue, excess amount, percentage	1.00%
Annualized health care expenditures, percentage	8.00%
Annualized health care expenditures, excess amount, percentage	4.00%
Tangible capital required for capital adequacy	$ 150,000
Annualized hospital expenditure paid percentage	4.00%

Commitments and Contingencies - Additonal Information (Details) - USD ($)	Mar. 31, 2021	Dec. 31, 2020
Loss Contingencies [Line Items]
Amounts accrued for legal proceedings	$ 0	$ 0