0000950170-23-058207 | 10-Q | XBRL Viewer

Accounts Receivable

9 Months Ended

Sep. 30, 2023

Accounts Receivable, after Allowance for Credit Loss [Abstract]

4. Accounts Receivable

Accounts receivable consisted of the following as of September 30, 2023 and December 31, 2022:


	September 30, 2023			December 31, 2022
Government receivables	$	29,367		$	33,200
Pharmacy rebate receivables		72,558			54,605
Other receivables		3,689			5,085
Total accounts receivable		105,614			92,890
Allowance for credit losses		(91	)		—
Accounts receivable, net	$	105,523		$	92,890

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 $40 and $39 during the three months ended September 30, 2023 and 2022, respectively, and $91 and $150 during the nine months ended September 30, 2023 and 2022. The amounts were recorded in selling general, and administrative expenses in the condensed consolidated statements of operations.

Long-Term Debt - Schedule of Future Maturities Under The Term Loan (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
2025	$ 1,650
2026	1,650
2027	161,700
Total	$ 165,000	$ 165,000

Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Property Plant and Equipment [Line Items]
Subtotal	$ 167,267	$ 142,333
Less accumulated depreciation	(120,105)	(105,164)
Property and equipment-net	47,162	37,169
Computer and equipment
Property Plant and Equipment [Line Items]
Subtotal	12,523	10,967
Office equipment and furniture
Property Plant and Equipment [Line Items]
Subtotal	4,417	4,470
Software
Property Plant and Equipment [Line Items]
Subtotal	141,006	119,308
Leasehold improvements
Property Plant and Equipment [Line Items]
Subtotal	6,158	6,561
Construction in progress
Property Plant and Equipment [Line Items]
Subtotal	$ 3,163	$ 1,027

Goodwill and Intangible Assets

9 Months Ended

Sep. 30, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

6. Goodwill and Intangible Assets

Intangible assets consisted of the following as of September 30, 2023 and December 31, 2022:


	September 30, 2023
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	34,826	$	—		$	34,826	—
License (indefinite lived)		4,967		—			4,967	—
Plan member relationships		2,700		(2,700	)		—	9 years
Other		1,050		(737	)		313	2 - 10 years
Total	$	43,543	$	(3,437	)	$	40,106


	December 31, 2022
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	34,810	$	—		$	34,810	—
License (indefinite lived)		4,967		—			4,967	—
Plan member relationships		2,700		(2,585	)		115	9 years
Other		1,050		(654	)		396	2 - 10 years
Total	$	43,527	$	(3,239	)	$	40,288

Amortization expense relating to intangible assets for the three months ended September 30, 2023 and 2022, was $27 and $96, respectively. Amortization expense relating to intangible assets for the nine months ended September 30, 2023 and 2022, was $198 and $289, respectively. Estimated amortization expense relating to intangible assets for each of the next five years ending December 31, is as follows:


Remainder of 2023	$	28
2024		82
2025		60
2026		60
2027		60
Thereafter		23
	$	313

There were no impairment charges related to goodwill and intangible assets for the three and nine months ended September 30, 2023 and 2022.

Commitments and Contingencies - Additonal Information (Details) - USD ($)		9 Months Ended
	Aug. 15, 2023	Sep. 30, 2023	Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Settlement date		August 15, 2023
Settlement amount	$ 912,500,000
Accrued for a potential liability		$ 912,500,000
Amounts accrued for legal proceedings		$ 0	$ 0

Fair Value

9 Months Ended

Sep. 30, 2023

Fair Value Disclosures [Abstract]

Fair Value

3. Fair Value

The following tables present the carrying value and fair value of these financial instruments as of September 30, 2023 and December 31, 2022:


	September 30, 2023
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	125,281	$	125,298	$	—	$	—
Certificate of deposits		1,777		—		1,777		—
Total	$	127,058	$	125,298	$	1,777	$	—


	December 31, 2022
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	1,383	$	—	$	1,383	$	—
Certificate of deposits		1,477		—		1,477		—
Total	$	2,860	$	—	$	2,860	$	—

The carrying value of long-term debt represents the outstanding balance, net of unamortized debt issuance costs. As of September 30, 2023 and December 31, 2022, the fair value of our long-term debt approximates the carrying value.

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. There was no such impairment as of September 30, 2023 and December 31, 2022.

U.S. Treasury Securities Investments

As of September 30, 2023, the Company had $123,876 of investments in U.S. Treasury bills which were classified as held to maturity and carried at amortized cost. These investments are included in short-term investments in the condensed consolidated balance sheets as the original maturities are greater than three months and less than twelve months. The Company has the intent and ability to hold these securities to maturity and gross unrecognized gains were $17. There were no U.S. treasury security investments included within short-term investments as of December 31, 2022.

As of September 30, 2023, the Company had $28 of investments in U.S. Treasury bills with an original maturity of less than three months. These investments are considered cash equivalents and are included in cash and cash equivalents in the condensed consolidated balances sheets. There were no U.S. treasury security investments included within cash and cash equivalents as of December 31, 2022.

Restricted Investments

Restricted investments are composed of investments in U.S. Treasury bills and certificates of deposits and are included within other assets in the condensed consolidated balance sheets. As of September 30, 2023 and December 31, 2022, the Company had $1,405 and $1,383 of restricted investments in U.S. Treasury bills and $1,777 and $1,477 of restricted investments in certificates of deposits, respectively. The Company has the intent and ability to hold these investments until maturity; therefore, these investments are stated at amortized cost. Restricted investments are required to be maintained at a financial institution within certain states. As of September 30, 2023 and December 31, 2022, these investments had maturities with less than 12 months. Due to the nature of the state's requirements, these assets are classified as noncurrent assets regardless of the contractual maturity date.

- 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

Goodwill and Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 43,543	$ 43,527
Accumulated Amortization	(3,437)	(3,239)
Finite Lived Intangible Assets Net	$ 40,106	$ 40,288
Weighted Average Life
Goodwill, Gross Carrying Value	$ 34,826	$ 34,810
Goodwill, Accumulated Amortization	0	0
Goodwill, Net Carrying Value	34,826	34,810
License (indefinite lived)
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	4,967	4,967
Accumulated Amortization	0	0
Finite Lived Intangible Assets Net	$ 4,967	$ 4,967
Weighted Average Life
Plan Member Relationship
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 2,700	$ 2,700
Accumulated Amortization	(2,700)	(2,585)
Finite Lived Intangible Assets Net	$ 0	$ 115
Weighted Average Life	9 years	9 years
Other
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 1,050	$ 1,050
Accumulated Amortization	(737)	(654)
Finite Lived Intangible Assets Net	$ 313	$ 396
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

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Operating Activities:
Net loss	$ (100,942)	$ (92,644)
Adjustments to reconcile net loss to net cash provided by operating activities:
Provision for credit loss	91	150
(Gain) loss on sublease	(289)	510
Depreciation and amortization	15,807	12,735
Amortization-investment discount	(3,349)	(8)
Amortization-debt issuance costs	1,037	1,616
Amortization of payment-in-kind interest	0	2,943
Equity-based compensation	51,183	58,833
Non-cash lease expense	1,653	2,151
Loss on extinguishment of debt	0	2,196
Changes in operating assets and liabilities:
Accounts receivable	(12,724)	(29,840)
Prepaid expenses and other current assets	(3,771)	(8,742)
Other assets	(119)	(137)
Medical expenses payable	33,299	45,509
Accounts payable and accrued expenses	(4,613)	2,030
Deferred premium revenue	146,034	116,298
Accrued compensation	7,604	7,484
Lease liabilities	(2,622)	(3,126)
Payment-in-kind interest	0	(14,122)
Net cash provided by operating activities	128,279	103,836
Investing Activities:
Purchase of business, net of cash received	0	(2,393)
Purchase of investments	(281,582)	(2,825)
Maturities of investments	160,735	2,425
Acquisition of property and equipment	(25,398)	(17,317)
Net cash used in investing activities	(146,245)	(20,110)
Financing Activities:
Repurchase of noncontrolling interest	0	(100)
Issuance of long-term debt	0	165,000
Debt issuance costs	0	(4,601)
Repayment of long-term debt	0	(143,179)
Contributions from noncontrolling interest holders	60	0
Net cash provided by financing activities	60	17,120
Net decrease in cash	(17,906)	100,846
Cash, cash equivalents and restricted cash at beginning of period	411,299	468,350
Cash, cash equivalents and restricted cash at end of period	393,393	569,196
Supplemental disclosure of cash flow information:
Cash paid for interest	13,943	22,447
Supplemental non-cash investing and financing activities:
Acquisition of property in accounts payable	117	290
Purchase of business in accounts payable	0	375
Reconciliation of cash, cash equivalents and restricted cash as shown in the statement of cash flows:
Cash and cash equivalents	391,643	567,446
Restricted cash in other assets	1,750	1,750
Total	$ 393,393	$ 569,196

Regulatory Requirements and Restricted Funds - Additional Information (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 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 as of September 30, 2023.
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%

Property and Equipment

9 Months Ended

Sep. 30, 2023

Property, Plant and Equipment [Abstract]

Property and Equipment

5. Property and Equipment

Property and equipment consisted of the following as of September 30, 2023 and December 31, 2022:


	September 30, 2023			December 31, 2022
Computers and equipment	$	12,523		$	10,967
Office equipment and furniture		4,417			4,470
Software		141,006			119,308
Leasehold improvements		6,158			6,561
Construction in progress		3,163			1,027
Subtotal		167,267			142,333
Less accumulated depreciation		(120,105	)		(105,164	)
Property and equipment-net	$	47,162		$	37,169

Depreciation expense for the three months ended September 30, 2023 and 2022 was $5,534 and $4,417, respectively, of which $64 and $57, respectively, were included in medical expenses. Depreciation expense for the nine months ended September 30, 2023 and 2022 was $15,609 and $12,446, respectively, of which $194 and $149, respectively, were included in medical expenses.

For the three and nine months ended September 30, 2023, $361 and $7,370, respectively, of operating lease assets were exchanged for lease liabilities related to newly commenced leases.

Medical Expenses Payable

9 Months Ended

Sep. 30, 2023

Insurance [Abstract]

Medical Expenses Payable

7. Medical Expenses Payable

The following table is a detail of medical expenses payable as of September 30, 2023 and December 31, 2022:


	September 30, 2023		December 31, 2022
Claims incurred but not paid	$	101,900	$	88,813
Capitation payable and risk-sharing payable		45,128		50,818
Other		56,407		30,504
Medical expenses payable	$	203,435	$	170,135

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 September 30, 2023 and 2022:


	September 30, 2023			September 30, 2022
Claims incurred but not paid - beginning balance	$	88,813		$	77,073
Incurred related to:
Current year		360,372			293,036
Prior years		(10,067	)		(15,757	)
Total incurred, net of reinsurance		350,305			277,279
Payments related to:
Current year		266,218			212,028
Prior years		71,000			56,689
Total payments, net of reinsurance		337,218			268,717
Claims incurred but not paid - ending balance		101,900			85,635
Capitation payable, risk-sharing payable, and other		101,535			85,760
Total medical expenses payable	$	203,435		$	171,395

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. Although the pandemic primarily impacted 2020 and 2021, the Delta and Omicron variants caused a rebound in COVID-related inpatient utilization during the first quarter of 2022. While COVID has had a less significant impact on 2023, we remain cautious of the potential impact of the COVID-19 in the future. 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 a favorable prior year development, excluding provision for adverse deviation, of $2,929 and $5,784 for the three and nine months ended September 30, 2023. The favorable prior year development was primarily due to better-than-expected claims recoveries and actual claims expense being less than expected.

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Allowance for credit losses	$ 91	$ 0
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	100,000,000	100,000,000
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	1,000,000,000
Common stock, shares issued	188,911,520	187,280,015
Common stock, shares outstanding	188,911,520	187,280,015

Summary of Significant Accounting Policies - Schedule of Property and Equipment Estimated Useful Lives (Details)	9 Months Ended
	Sep. 30, 2023
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)

Fair Value - Schedule of Carrying Value and Fair Value of Financial Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	$ 127,058	$ 2,860
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	125,298	0
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,777	2,860
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
US Treasury Bills
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	125,281	1,383
US Treasury Bills \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	125,298	0
US Treasury Bills \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	1,383
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	1,777	1,477
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	1,777	1,477
Certificate of Deposits \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	$ 0	$ 0

Organization

9 Months Ended

Sep. 30, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Organization

1. Organization

Alignment Healthcare, Inc. (collectively, “we” or “us” or “our” or the “Company”), 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 Medicare Advantage Plans in the states of California, North Carolina, Nevada, Arizona, Florida and Texas.

Equity-Based Compensation

9 Months Ended

Sep. 30, 2023

Share-Based Payment Arrangement [Abstract]

Equity-Based Compensation

10. Equity-Based Compensation

Equity Awards

Stock options

Our outstanding stock options generally vest 25% annually over four years and generally expire 10 years from the date of the grant. The 2021 Equity Incentive Plan provides that stock option grants will be made with an exercise price 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 three and nine months ended September 30, 2023:


	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, 2022		10,603,493		$	16.90		8.30	$	3,519
Options granted		—			—
Options exercised		—			—
Options forfeited / expired		(19,369	)		18.41
Balances as of March 31, 2023		10,584,124		$	16.90		8.05		—
Options granted		—			—
Options exercised		—			—
Options forfeited / expired		(17,595	)		17.94
Balances as of June 30, 2023		10,566,529		$	16.90		7.80		—
Options granted		—			—
Options exercised		—			—
Options forfeited / expired		(294,500	)		16.47
Balances as of September 30, 2023		10,272,029		$	16.91		7.55		—
Vested and Exercisable as of September 30, 2023		4,951,671		$	17.43		7.48		—

Aggregate intrinsic value represents the difference between the exercise price of the option and the closing price of our common stock. For the three months ended September 30, 2023 and 2022 and nine months ended September 30, 2023 and 2022, no options were exercised. No options were granted during the three and nine months ended September 30, 2023.

Restricted Stock Awards

Our outstanding RSAs 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.

The following is a summary of RSA transactions for the three and nine months ended September 30, 2023:


	Restricted Shares			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2022		4,690,441		$	10.85
Vested		(2,083,984	)		15.89
Forfeited		(9,514	)		9.27
Unvested and outstanding as of March 31, 2023		2,596,943		$	6.81
Vested		(89,370	)		9.42
Forfeited		(5,708	)		9.27
Unvested and outstanding as of June 30, 2023		2,501,865		$	6.71
Vested		(1,503,672	)		7.15
Forfeited		(20,375	)		2.49
Unvested and outstanding as of September 30, 2023		977,818		$	6.13

Restricted Stock Units

Our outstanding RSUs generally vest 25% annually over four years.

The following is a summary of RSU transactions for the three and nine months ended September 30, 2023:


	Restricted Stock Units			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2022		8,728,936		$	13.93
Granted		2,549,551			6.97
Vested		(1,204,777	)		11.95
Cancelled/forfeited		(68,865	)		13.18
Unvested and outstanding as of March 31, 2023		10,004,845		$	12.40
Granted		244,349			7.06
Vested		(43,195	)		10.52
Cancelled/forfeited		(60,406	)		10.71
Unvested and outstanding as of June 30, 2023		10,145,593		$	12.29
Granted		1,034,421			5.75
Vested		(419,130	)		14.72
Cancelled/forfeited		(183,355	)		11.53
Unvested and outstanding as of September 30, 2023		10,577,529		$	11.57

Performance-based Restricted Stock Units ("PSUs")

On September 14, 2023, the Board of Directors of the Company approved the grant of performance-based restricted stock units under the Company's 2021 Equity Incentive Plan to its executive management team and other key employees. Each grantee is eligible to vest in a number of PSUs ranging from 0% to 150% of the target number of PSUs granted, based on the aggregated achievement by the Company of certain performance metrics during the performance period beginning on January 1, 2024 and ending on December 31, 2024. The achievement of PSUs relative to the approved target is based on the following performance metrics and relative weighting: Health Plan Revenue Growth Percentage (60%), At-Risk Returning Member Medical Benefit Ratio (20%) and Adjusted EBITDA, less Capital Expenditures (20%).

50% of the total number of earned PSUs will become vested upon certification of achievement of the performance metrics by the Compensation Committee on or about March 1, 2025 and the remaining 50% of earned PSUs will be become vested as of December 31, 2025, subject to continued service to the Company through such dates.

The following is a summary of PSU transactions for the three and nine months ended September 30, 2023:


	Performance-based restricted stock units		Weighted-Average Grant Date Fair Value
Unvested and outstanding as of June 30, 2023		—	$	—
Granted		5,564,005		5.74
Vested		—		—
Cancelled/forfeited		—		—
Unvested and outstanding as of September 30, 2023		5,564,005	$	5.74

Equity-Based Compensation Expense

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


	Three Months Ended September 30,				Nine Months Ended September 30,
(amounts in thousands)	2023		2022		2023		2022
Selling, general and administrative expenses	$	11,836	$	16,775	$	45,159	$	52,082
Medical expenses		1,733		1,912		6,024		6,751
Total equity-based compensation expense	$	13,569	$	18,687	$	51,183	$	58,833

As of September 30, 2023, there was $116,294 in unrecognized compensation expense related to all non-vested awards (RSAs, options, RSUs and PSUs) that will be recognized over the weighted-average period of 2.04 years.

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		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Numerator:
Net loss	$ (35,077)	$ (40,247)	$ (100,942)	$ (92,644)
Less: Net loss attributable to noncontrolling interest	30	0	134	0
Net loss attributable to Alignment Healthcare, Inc.	$ (35,047)	$ (40,247)	$ (100,808)	$ (92,644)
Denominator:
Total weighted-average common shares outstanding - basic	188,657,282	187,267,619	188,241,025	187,216,118
Total weighted-average common shares outstanding - diluted	188,657,282	187,267,619	188,241,025	187,216,118
Less: Restricted shares of common stock	(1,328,964)	(5,144,256)	(2,747,680)	(6,450,818)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic	187,328,318	182,123,363	185,493,345	180,765,300
Total weighted-average common shares outstanding, net of restricted shares of common stock - diluted	187,328,318	182,123,363	185,493,345	180,765,300
Earnings Per Share, Basic [Abstract]
Net loss per share - basic	$ (0.19)	$ (0.22)	$ (0.54)	$ (0.51)
Earnings Per Share, Diluted [Abstract]
Net loss per share - diluted	$ (0.19)	$ (0.22)	$ (0.54)	$ (0.51)

Fair Value - Additional Information (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Asset Impairment Charges	$ 0	$ 0
US Treasury Bill Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investments	123,876	0
Gross Unrecognized Gains	17
Restricted investments	1,405	1,383
US Treasury Bill Securities \| Cash and Cash Equivalents
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investments		0
Less Than Three Months Maturity US Treasury Bills
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investments	28
Certificate of Deposits
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Restricted investments	$ 1,777	$ 1,477

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2023	Oct. 30, 2023
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
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	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	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		189,099,787

Property and Equipment (Tables)

9 Months Ended

Sep. 30, 2023

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment consisted of the following as of September 30, 2023 and December 31, 2022:


	September 30, 2023			December 31, 2022
Computers and equipment	$	12,523		$	10,967
Office equipment and furniture		4,417			4,470
Software		141,006			119,308
Leasehold improvements		6,158			6,561
Construction in progress		3,163			1,027
Subtotal		167,267			142,333
Less accumulated depreciation		(120,105	)		(105,164	)
Property and equipment-net	$	47,162		$	37,169

Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Property Plant and Equipment [Line Items]
Depreciation expense	$ 5,534	$ 4,417	$ 15,609	$ 12,446
Operating lease assets obtained in exchange for lease liabilities	361		7,370
Medical Expenses
Property Plant and Equipment [Line Items]
Depreciation expense	$ 64	$ 57	$ 194	$ 149

Regulatory Requirements and Restricted Funds

9 Months Ended

Sep. 30, 2023

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, health maintenance organizations ("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 have adopted the RBC rules. Our health plans or risk-bearing entities were in compliance with the minimum capital requirements as of September 30, 2023.

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 as of September 30, 2023.

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 September 30, 2023.

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 other assets on the condensed consolidated balance sheets.

We hold these assets until maturity, at which time these assets will renew or are invested in a similar type of investment instrument. Given the regulatory requirements, we expect to hold these investments for long-term. 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.

Summary of Significant Accounting Policies (Policies)

9 Months Ended

Sep. 30, 2023

Accounting Policies [Abstract]

Basis of Presentation

The accompanying 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”). The condensed consolidated financial statements include the accounts of the Company, our subsidiaries, and three immaterial variable interest entities in which we are the primary beneficiary. All intercompany transactions have been eliminated in consolidation. Noncontrolling interest is presented within the equity section of the condensed consolidated balance sheets.

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net income (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; 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”) who regularly reviews financial operating results on a consolidated basis for purposes of allocating resources and evaluating financial performance. We operate and manage the business as one reportable segment and one operating segment, which is to provide healthcare services to our seniors. 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, cash equivalents, restricted cash and U.S. Treasury bills was determined based on Level 1 inputs. The fair value of certificate of deposits, which are recorded in 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 as of September 30, 2023 and December 31, 2022. Our long-term debt was reported at carrying value.

Revenue and Accounts Receivable

Earned premium revenue consisted of premium revenue and capitation revenue for the three and nine months ended September 30, 2023 and 2022 were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2023		2022		2023		2022
Premium	$	417,867	$	345,415	$	1,242,311	$	1,027,400
Capitation		32,368		14,563		99,613		44,050
Total	$	450,235	$	359,978	$	1,341,924	$	1,071,450

Premium revenue is derived monthly from the federal government based on our contracts with the Centers for Medicare and Medicaid Services (“CMS”). In accordance with these arrangements, 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 per month (“PMPM”), which is adjusted based on certain risk factors derived from medical diagnoses and conditions of 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 third-party payors and from CMS related to our participation in the CMS "ACO Realizing Equity, Access, and Community Health Model” or “ACO REACH” model, as discussed below.

Under those arrangements with third-party payors, 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 the 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.

On April 1, 2021, we began participating in the CMS Innovation’s Direct Contracting Model. CMS serves as the claim adjudicator for institutional and specialists care, and directly pays for such fee for service claims. CMS replaced the Direct Contracting Entity ("DCE") program with the ACO REACH model, effective January 1, 2023. The ACO REACH entity ("ACO") is responsible for the cost of health care services related to the patient population attributed to the ACO by participating in 100% savings/losses via the risk share model and in some cases, are financially responsible for the supplemental benefits provided to the patients. The ACO acts as a principal in arranging for and controlling services provided directly by their contracts with primary care physicians, as well as services provided by preferred institutional care providers and specialists. Capitation payments for the ACO program are determined from an annual benchmark established by CMS. These payments, which are adjusted for variable considerations, represent revenue for providing health care services, including primary care as well as institutional and specialist care. The ACO recognizes capitation revenue for providing these services in the period in which the performance obligations are satisfied by transferring services to the members. Revenue recognized by the ACO for the three and nine months ended September 30, 2023 was $30,476 and $92,703, respectively. Revenue recognized by the DCE for the three and nine months ended September 30, 2022 was $12,341 and $37,753, respectively.

Interest income earned on our cash deposits and short-term investments is included within other revenue on the condensed consolidated statements of operations. Interest income for the three and nine months ended September 30, 2023 was $5,523 and $13,967, respectively. Interest income for the three and nine months ended September 30, 2022 was $29 and $37, respectively.

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, Nevada, Arizona, Texas and Florida 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 defines what constitutes medical costs and premium revenue, including certain additional expenses related to improving the quality of care provided, and the exclusion of 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. The amounts payable under this provision were immaterial at September 30, 2023 and December 31, 2022.

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 premium 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.

Variable consideration estimates related to ACO contract revenue are based on the most likely outcome method and that a significant reversal in the amount of cumulative revenue recognized would not occur.

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.

We typically receive our monthly premium payments from CMS on the first day of the month. However, as the first day of October did not occur on a business day, we received the October premium payment on the last day of September. Accordingly, at September 30, 2023, we recorded deferred premium revenue of $146,342. This amount will be recognized as part of revenue in October 2023. Historically we have presented deferred premium revenue within accounts payable and accrued expenses within the condensed consolidated balance sheet. However, this period we have presented deferred premium revenue as a separate line item and have reclassified prior period balances for comparative purposes. At December 31, 2022, deferred premium revenue was $308.

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 Expenses Payable

Medical Expenses

Medical expenses include 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 compensate 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. We also record claims expenses related to our institutional and specialist care related to our ACO program with CMS as we act as the principal in the transaction.

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.

In August 2022, the Inflation Reduction Act ("IRA") was signed into law. The law intends to increase tax revenue and reduce Medicare costs through lower prescription drug prices, inflation rebates, and capping annual Medicare Part D out of pocket expenses. The provisions of the law are set to take effect over the next seven years. We are in the process of evaluating the impact the IRA will have on our business.

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”), which includes an estimate for claims incurred but not reported (“IBNR”) and a payable for adjudicated claims. IBNR is estimated using an actuarial process that is consistently applied and centrally controlled. Medical expenses payable also includes an estimate for the costs necessary to process unpaid claims at the end of each period. We estimate the IBNR 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 cost trends and completion factors that are assessed based on historical data for payment patterns, product mix, seasonality, utilization of health care services, and other relevant factors. Each period, we re-examine previously established IBNR estimates based on actual claim submissions and other changes in facts and circumstances. As the IBNR 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 IBNP 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 or payables.

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 September 30, 2023 and December 31, 2022, 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 September 30, 2023 and December 31, 2022, there was $390,047 and $408,047, respectively, in excess of FDIC-insured limits.

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, we utilize the simplified method available under U.S. GAAP. As we do not have a substantial trading history, volatility assumptions were developed using a combination of the Company's historical volatility and 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 graded vesting schedule over the requisite service period of the awards, which is generally four years.

Equity-based compensation expense for RSU awards with performance-based vesting is recognized over the requisite service period on a graded vesting schedule and is only recognized when the Company concludes that it is probable that the performance condition(s) will be achieved. At each reporting period, the Company reassesses the probability of achieving the performance criteria. Determining whether the performance criteria will be achieved involves judgment, and the estimate of share-based compensation expense may be revised periodically based on changes in the probability of achieving the performance criteria. Revisions are reflected in the period in which the estimate is changed. We account for forfeitures as they occur.

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

Noncontrolling Interest

Noncontrolling interest

In April 2021, the Company acquired a noncontrolling interest representing the portion of equity ownership in a subsidiary that is not attributable to Alignment Healthcare, Inc. The noncontrolling interest in a subsidiary was initially recognized at estimated fair value and was presented within total equity in the Company's condensed consolidated balance sheets. There was no net loss attributable to the noncontrolling interest for the three and nine months ended September 30, 2022 as the Company was responsible for 100% of the net loss in the first year of operations of that subsidiary. During 2022, the Company purchased this noncontrolling interest and now owns 100% of that subsidiary.

In October 2022, the Company acquired a subsidiary and recorded a noncontrolling interest for the portion of equity ownership not attributable to Alignment Healthcare, Inc. The noncontrolling interest in the subsidiary was initially recognized at estimated fair value on October 1, 2022 and is presented within total equity in the Company's condensed consolidated balance sheet. The net loss attributable to this noncontrolling interest was $30 and $134, respectively, for the three and nine months ended September 30, 2023.

Net Income (Loss) per Share

Net Loss per Share

Net loss per share is calculated based on net loss attributable to Alignment Healthcare, Inc.'s stockholders. The following table sets forth the computation of basic and diluted net loss per share for the three and nine months ended September 30, 2023 and 2022:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2023			2022			2023			2022
Numerator:
Net loss	$	(35,077	)	$	(40,247	)	$	(100,942	)	$	(92,644	)
Less: Net loss attributable to noncontrolling interests		30			—			134			—
Net loss attributable to Alignment Healthcare, Inc.	$	(35,047	)	$	(40,247	)	$	(100,808	)	$	(92,644	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		188,657,282			187,267,619			188,241,025			187,216,118
Less: Restricted shares of common stock		(1,328,964	)		(5,144,256	)		(2,747,680	)		(6,450,818	)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		187,328,318			182,123,363			185,493,345			180,765,300
Net loss per share:
Net loss per share - basic and diluted	$	(0.19	)	$	(0.22	)	$	(0.54	)	$	(0.51	)

Basic net loss per share is the same as diluted net loss per share for certain periods presented 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 as of September 30, 2023 and 2022:


	September 30,
	2023		2022
Stock options		10,272,029		10,598,474
Restricted stock units		16,141,534		8,661,679
Total		26,413,563		19,260,153

Recent Accounting Pronouncements Adopted

From time to time, new accounting pronouncements are issued by the Financial Accounting Standards Board ("FASB") or other standard setting bodies that are adopted by the Company as of the specified effective date. Unless otherwise discussed, the Company believes

that the impact of recently issued standards that are not yet effective will not have a material impact on the Company’s consolidated financial position or results of operations upon adoption.

Summary of Significant Accounting Policies - Schedule of Computation of Diluted Net Loss Per Share (Details) - shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Total	26,413,563	19,260,153
Restricted Stock Units
Total	16,141,534	8,661,679
Stock Option
Total	10,272,029	10,598,474

Medical Expenses Payable (Tables)

9 Months Ended

Sep. 30, 2023

Insurance [Abstract]

Schedule of Medical Expenses Payable

The following table is a detail of medical expenses payable as of September 30, 2023 and December 31, 2022:


	September 30, 2023		December 31, 2022
Claims incurred but not paid	$	101,900	$	88,813
Capitation payable and risk-sharing payable		45,128		50,818
Other		56,407		30,504
Medical expenses payable	$	203,435	$	170,135

Components of Change in Medical Expenses Payable

The following table presents components of the change in medical expenses payable as of September 30, 2023 and 2022:


	September 30, 2023			September 30, 2022
Claims incurred but not paid - beginning balance	$	88,813		$	77,073
Incurred related to:
Current year		360,372			293,036
Prior years		(10,067	)		(15,757	)
Total incurred, net of reinsurance		350,305			277,279
Payments related to:
Current year		266,218			212,028
Prior years		71,000			56,689
Total payments, net of reinsurance		337,218			268,717
Claims incurred but not paid - ending balance		101,900			85,635
Capitation payable, risk-sharing payable, and other		101,535			85,760
Total medical expenses payable	$	203,435		$	171,395

Long-Term Debt (Tables)

9 Months Ended

Sep. 30, 2023

Debt Disclosure [Abstract]

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

Long-term debt is recorded at carrying value in the condensed consolidated balance sheets. The carrying value of long-term debt outstanding, net of unamortized debt issuance costs, consisted of the following as of September 30, 2023 and December 31, 2022:


	September 30, 2023			December 31, 2022
Long-term debt	$	165,000		$	165,000
Less unamortized debt issuance costs		(3,405	)		(4,098	)
Long-term debt-net of amortization		161,595			160,902
Less current portion of long-term debt		—			—
Long-term debt - net of current portion	$	161,595		$	160,902

Schedule of Future Maturities Under The Term Loan

Future maturities under the term loan as of September 30, 2023 are as follows:


Period Ending September 30,	Amount
2023	$	—
2024		—
2025		1,650
2026		1,650
2027		161,700
	$	165,000

Income Taxes

9 Months Ended

Sep. 30, 2023

Income Tax Disclosure [Abstract]

Income Taxes

9. Income Taxes

For the three and nine months ended September 30, 2023, we recorded income tax expense of $0 and $2, respectively. For the three and nine months ended September 30, 2022, we recorded income tax expense of $167 and $167, respectively. The decrease in tax for the three and nine months ended September 30, 2023 when compared to the three and nine months ended September 30, 2022, is primarily attributable to state tax. Our future effective tax rate may vary from the statutory tax rate primarily due to changes in our valuation allowance, state taxes, and excess executive compensation.

We have federal and state cumulative net operating losses ("NOLs") as of September 30, 2023 and December 31, 2022. 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 September 30, 2023 and 2022. Under the Tax Cuts and Jobs Act (“TCJA”), federal NOLs generated after 2017 will be carried forward indefinitely but are limited to an 80% deduction of taxable income. NOLs generated prior to 2018 have a 20-year carryforward period and can be used to offset 100% of taxable income. An exception to the TCJA federal NOL rule applies to certain of our subsidiaries and requires all NOLs generated from those entities to have a 20-year carryforward period and offset 100% of taxable income. For the year ended December 31, 2022 federal and state NOL carryforwards were $426,440 and $454,522, respectively. $234,742 of the total federal net operating loss carryforwards have an indefinite life while the remaining federal and state net operating loss carryforwards begin to expire in 2033 if not utilized.

An “ownership change” as defined under Section 382 of the Internal Revenue Code ("IRC"), 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 a 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-17

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Summary of Significant Accounting Policies

9 Months Ended

Sep. 30, 2023

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Basis of Presentation

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net income (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

Level 2 inputs. There were no assets or liabilities measured at fair value using Level 3 inputs as of September 30, 2023 and December 31, 2022. Our long-term debt was reported at carrying value.

Revenue and Accounts Receivable

Earned premium revenue consisted of premium revenue and capitation revenue for the three and nine months ended September 30, 2023 and 2022 were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2023		2022		2023		2022
Premium	$	417,867	$	345,415	$	1,242,311	$	1,027,400
Capitation		32,368		14,563		99,613		44,050
Total	$	450,235	$	359,978	$	1,341,924	$	1,071,450

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

Medical Expenses Payable

Part D Subsidies

Shared Risk Reserve Arrangements

Concentrations of Credit Risk

Equity-Based Compensation

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

Noncontrolling interest

Net Loss per Share


	Three Months Ended September 30,						Nine Months Ended September 30,
	2023			2022			2023			2022
Numerator:
Net loss	$	(35,077	)	$	(40,247	)	$	(100,942	)	$	(92,644	)
Less: Net loss attributable to noncontrolling interests		30			—			134			—
Net loss attributable to Alignment Healthcare, Inc.	$	(35,047	)	$	(40,247	)	$	(100,808	)	$	(92,644	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		188,657,282			187,267,619			188,241,025			187,216,118
Less: Restricted shares of common stock		(1,328,964	)		(5,144,256	)		(2,747,680	)		(6,450,818	)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		187,328,318			182,123,363			185,493,345			180,765,300
Net loss per share:
Net loss per share - basic and diluted	$	(0.19	)	$	(0.22	)	$	(0.54	)	$	(0.51	)

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


	September 30,
	2023		2022
Stock options		10,272,029		10,598,474
Restricted stock units		16,141,534		8,661,679
Total		26,413,563		19,260,153

Recent Accounting Pronouncements Adopted

that the impact of recently issued standards that are not yet effective will not have a material impact on the Company’s consolidated financial position or results of operations upon adoption.

Equity-Based Compensation - Summary of RSAs Transactions (Details) - Restricted Stock Awards - $ / shares	3 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Unvested and Outstanding, Beginning Balance	2,501,865	2,596,943	4,690,441
Vested	(1,503,672)	(89,370)	(2,083,984)
Forfeited	(20,375)	(5,708)	(9,514)
Unvested and Outstanding, Ending Balance	977,818	2,501,865	2,596,943
Weighted-Average Grant Date Fair Value, Beginning Balance	$ 6.71	$ 6.81	$ 10.85
Weighted-Average Grant Date Fair Value, Vested	7.15	9.42	15.89
Weighted-Average Grant Date Fair Value, Forfeited	2.49	9.27	9.27
Weighted-Average Grant Date Fair Value, Ending Balance	$ 6.13	$ 6.71	$ 6.81

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 1D
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480483/718-10-35-1D

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 35
-Paragraph 3
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-URI https://asc.fasb.org//1943274/2147480483/718-10-35-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (a)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-SubTopic 10
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-Section 50
-Paragraph 2
-Subparagraph (a)(3)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(i)
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
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-Subparagraph (c)(1)(ii)
-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
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-Section 50
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-Subparagraph (c)(1)(iii)
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(01)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Paragraph 2
-Subparagraph (c)(1)(iv)(02)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(03)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
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-Paragraph 2
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Paragraph 2
-Subparagraph (c)(2)(iii)(01)
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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Reference 20: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 24: http://www.xbrl.org/2003/role/disclosureRef
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Reference 25: http://www.xbrl.org/2003/role/disclosureRef
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Reference 26: http://www.xbrl.org/2003/role/disclosureRef
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Reference 27: http://www.xbrl.org/2003/role/disclosureRef
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Reference 28: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

+ Details

Medical Expenses Payable - Components of Change in Medical Expenses Payable (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Insurance [Abstract]
Claims incurred but not paid - beginning balance	$ 88,813	$ 77,073
Incurred related to:
Current year	360,372	293,036
Prior years	(10,067)	(15,757)
Total incurred, net of reinsurance	350,305	277,279
Payments related to:
Current year	266,218	212,028
Prior years	71,000	56,689
Total payments, net of reinsurance	337,218	268,717
Claims incurred but not paid - ending balance	101,900	85,635
Capitation payable, risk-sharing payable, and other	101,535	85,760
Total medical expenses payable	$ 203,435	$ 171,395	$ 170,135

Goodwill and Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Indefinite-Lived Intangible Assets [Line Items]
Amortization expense	$ 27	$ 96	$ 198	$ 289
Impairment charges	$ 0	$ 0	$ 0	$ 0

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Operating Loss Carryforwards [Line Items]
Income tax expense	$ 0	$ 167	$ 2	$ 167
NOL carryforwards indefinite life					$ 234,742
NOL carryforwards expiration year			2033
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
NOL carryforwards					426,440
Taxable income deduction limit percentage			80.00%
Carryforward Offset Percentage Of Taxable Income	100.00%		100.00%
Domestic Tax Authority \| Subsidiaries
Operating Loss Carryforwards [Line Items]
Carryforward Offset Percentage Of Taxable Income	100.00%		100.00%
State and Local Jurisdiction
Operating Loss Carryforwards [Line Items]
NOL carryforwards					$ 454,522

Equity-Based Compensation - Additional Information (Details) - USD ($)				3 Months Ended			9 Months Ended
	Dec. 31, 2025	Mar. 01, 2025	Sep. 14, 2023	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Aggregate intrinsic value, options exercised				$ 0		$ 0	$ 0	$ 0
Options granted, fair value				$ 0			0
Share based compensation expense, unrecognized							$ 116,294,000
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%
Award vesting period							4 years
Pre-IPO Awards Converted RSAs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage							50.00%
Performance-based Restricted Stock Units
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Share based payment award, description and terms							The achievement of PSUs relative to the approved target is based on the following performance metrics and relative weighting: Health Plan Revenue Growth Percentage (60%), At-Risk Returning Member Medical Benefit Ratio (20%) and Adjusted EBITDA, less Capital Expenditures (20%).
Performance-based Restricted Stock Units \| Scenario Forecast
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage	50.00%	50.00%
Performance-based Restricted Stock Units \| Minimum
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage			0.00%
Performance-based Restricted Stock Units \| Maximum
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage			150.00%
RSUs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage					25.00%
Award vesting period					4 years
Non-vested awards RSAs, options and RSUs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Weighted average contractual term							2 years 14 days

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current Assets:
Cash and cash equivalents	$ 391,643	$ 409,549
Accounts receivable (less allowance for credit losses of $91 at September 30, 2023 and $0 at December 31, 2022, respectively)	105,523	92,890
Short-term investments	123,926	0
Prepaid expenses and other current assets	45,878	42,107
Total current assets	666,970	544,546
Property and equipment, net	47,162	37,169
Right of use asset, net	10,472	5,825
Goodwill and intangible assets, net	40,106	40,288
Other assets	6,082	6,035
Total assets	770,792	633,863
Current Liabilities:
Medical expenses payable	203,435	170,135
Accounts payable and accrued expenses	25,356	31,980
Deferred premium revenue	146,342	308
Accrued compensation	35,141	27,538
Total current liabilities	410,274	229,961
Long-term debt, net of debt issuance costs	161,595	160,902
Long-term portion of lease liabilities	9,318	3,698
Total liabilities	581,187	394,561
Commitments and Contingencies (Note 12)
Stockholders' Equity:
Preferred stock, $.001 par value; 100,000,000 and 100,000,000 shares authorized as of September 30, 2023 and December 31, 2022, respectively; no shares issued and outstanding as of September 30, 2023 and December 31, 2022	0	0
Common stock, $.001 par value; 1,000,000,000 shares authorized as of September 30, 2023 and December 31, 2022; 188,911,520 and 187,280,015 shares issued and outstanding as of September 30, 2023 and December 31, 2022, respectively	189	187
Additional paid-in capital	1,021,363	970,180
Accumulated deficit	(833,049)	(732,241)
Total Alignment Healthcare, Inc. stockholders' equity	188,503	238,126
Noncontrolling interest	1,102	1,176
Total stockholders' equity	189,605	239,302
Total liabilities and stockholders' equity	$ 770,792	$ 633,863

Medical Expenses Payable - Schedule of Medical Expenses Payable (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022	Sep. 30, 2022	Dec. 31, 2021
Insurance [Abstract]
Claims incurred but not paid	$ 101,900	$ 88,813	$ 85,635	$ 77,073
Capitation payable and risk-sharing payable	45,128	50,818
Other	56,407	30,504
Total medical expenses payable	$ 203,435	$ 170,135	$ 171,395

Fair Value (Tables)

9 Months Ended

Sep. 30, 2023

Fair Value Disclosures [Abstract]

Schedule of Carrying Value and Fair Value of Financial Instruments

The following tables present the carrying value and fair value of these financial instruments as of September 30, 2023 and December 31, 2022:


	September 30, 2023
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	125,281	$	125,298	$	—	$	—
Certificate of deposits		1,777		—		1,777		—
Total	$	127,058	$	125,298	$	1,777	$	—


	December 31, 2022
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	1,383	$	—	$	1,383	$	—
Certificate of deposits		1,477		—		1,477		—
Total	$	2,860	$	—	$	2,860	$	—

Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Noncontrolling Interest
Beginning Balance at Dec. 31, 2021	$ 306,055	$ 187	$ 888,547	$ (582,694)	$ 15
Beginning Balance, Shares at Dec. 31, 2021		187,193,613
Net loss	(92,644)	$ 0	0	(92,644)	0
Issuance of common stock upon vesting of restricted stock units, shares		433,440
Forfeitures	0	$ 0	0	0	0
Forfeitures, shares		(363,077)
Equity-based compensation	58,833	$ 0	58,833	0	0
Repurchase of noncontrolling interest attributable to subsidiary	(100)	0	(85)	0	(15)
Ending Balance at Sep. 30, 2022	272,144	$ 187	947,295	(675,338)	0
Ending Balance, Shares at Sep. 30, 2022		187,263,976
Beginning Balance at Jun. 30, 2022	293,704	$ 187	928,608	(635,091)	0
Beginning Balance, Shares at Jun. 30, 2022		187,271,311
Net loss	(40,247)	$ 0	0	(40,247)	0
Issuance of common stock upon vesting of restricted stock units, shares		956
Forfeitures	0	$ 0	0	0	0
Forfeitures, shares		(8,291)
Equity-based compensation	18,687	$ 0	18,687	0	0
Ending Balance at Sep. 30, 2022	272,144	$ 187	947,295	(675,338)	0
Ending Balance, Shares at Sep. 30, 2022		187,263,976
Beginning Balance at Dec. 31, 2022	$ 239,302	$ 187	970,180	(732,241)	1,176
Beginning Balance, Shares at Dec. 31, 2022	187,280,015	187,280,015
Net loss	$ (100,942)	$ 0	0	(100,808)	(134)
Issuance of common stock upon vesting of restricted stock units, shares		1,667,102
Issuance of common stock upon vesting of restricted stock units	2	$ 2
Forfeitures	0	$ 0	0	0	0
Forfeitures, shares		(35,597)
Equity-based compensation	51,183	$ 0	51,183	0	0
Repurchase of noncontrolling interest attributable to subsidiary	60	0	0	0	60
Ending Balance at Sep. 30, 2023	$ 189,605	$ 189	1,021,363	(833,049)	1,102
Ending Balance, Shares at Sep. 30, 2023	188,911,520	188,911,520
Beginning Balance at Jun. 30, 2023	$ 211,112	$ 188	1,007,794	(798,002)	1,132
Beginning Balance, Shares at Jun. 30, 2023		188,512,765
Net loss	(35,077)	$ 0	0	(35,047)	(30)
Issuance of common stock upon vesting of restricted stock units, shares		419,130
Issuance of common stock upon vesting of restricted stock units	1	$ 1
Forfeitures	0	$ 0	0	0	0
Forfeitures, shares		(20,375)
Equity-based compensation	13,569	$ 0	13,569	0	0
Ending Balance at Sep. 30, 2023	$ 189,605	$ 189	$ 1,021,363	$ (833,049)	$ 1,102
Ending Balance, Shares at Sep. 30, 2023	188,911,520	188,911,520

- Definition

The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

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Amount of equity (deficit) attributable to parent and noncontrolling interest. Excludes temporary equity.

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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Section 65
-Paragraph 15
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 24: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Summary of Significant Accounting Policies (Tables)

9 Months Ended

Sep. 30, 2023

Accounting Policies [Abstract]

Schedule of Earned Revenue

Earned premium revenue consisted of premium revenue and capitation revenue for the three and nine months ended September 30, 2023 and 2022 were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2023		2022		2023		2022
Premium	$	417,867	$	345,415	$	1,242,311	$	1,027,400
Capitation		32,368		14,563		99,613		44,050
Total	$	450,235	$	359,978	$	1,341,924	$	1,071,450

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 and nine months ended September 30, 2023 and 2022:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2023			2022			2023			2022
Numerator:
Net loss	$	(35,077	)	$	(40,247	)	$	(100,942	)	$	(92,644	)
Less: Net loss attributable to noncontrolling interests		30			—			134			—
Net loss attributable to Alignment Healthcare, Inc.	$	(35,047	)	$	(40,247	)	$	(100,808	)	$	(92,644	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		188,657,282			187,267,619			188,241,025			187,216,118
Less: Restricted shares of common stock		(1,328,964	)		(5,144,256	)		(2,747,680	)		(6,450,818	)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		187,328,318			182,123,363			185,493,345			180,765,300
Net loss per share:
Net loss per share - basic and diluted	$	(0.19	)	$	(0.22	)	$	(0.54	)	$	(0.51	)

Schedule of Computation of Diluted Net Loss Per Share


	September 30,
	2023		2022
Stock options		10,272,029		10,598,474
Restricted stock units		16,141,534		8,661,679
Total		26,413,563		19,260,153

Equity-Based Compensation - Summary of Stock Option Activity Transactions (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended			12 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Options Outstanding, Beginning Balance	10,566,529	10,584,124	10,603,493
Options Granted			0
Options Exercised			0
Options Forfeited / Expired	(294,500)	(17,595)	(19,369)
Options Outstanding, Ending Balance	10,272,029	10,566,529	10,584,124	10,603,493
Options Outstanding, Vested and Exercisable		4,951,671
Weighted-Average Exercise Price Per Option, Beginning Balance	$ 16.91	$ 16.9	$ 16.9	$ 16.90
Weighted-Average Exercise Price Per Option, Options Granted			0
Weighted-Average Exercise Price Per Option, Options Exercised			0
Weighted-Average Exercise Price Per Option, Options Forfeited / Expired	16.47	17.94	18.41
Weighted-Average Exercise Price Per Option, Ending Balance	$ 16.91	16.9	$ 16.9	$ 16.90
Weighted- Average Exercise Price, Vested and Exercisable		$ 17.43
Weighted-Average Remaining Contractual Terms, Outstanding	7 years 6 months 18 days	7 years 9 months 18 days	8 years 18 days	8 years 3 months 18 days
Weighted-Average Remaining Contractual Terms, Vested and Expected to Vest		7 years 5 months 23 days
Aggregate Intrinsic Value			$ 3,519
Aggregate Intrinsic Value, Vested and Expected to Vest		$ 0

Accounts Receivable (Tables)

9 Months Ended

Sep. 30, 2023

Accounts Receivable, after Allowance for Credit Loss [Abstract]

Schedule of Accounts Receivable

Accounts receivable consisted of the following as of September 30, 2023 and December 31, 2022:


	September 30, 2023			December 31, 2022
Government receivables	$	29,367		$	33,200
Pharmacy rebate receivables		72,558			54,605
Other receivables		3,689			5,085
Total accounts receivable		105,614			92,890
Allowance for credit losses		(91	)		—
Accounts receivable, net	$	105,523		$	92,890

Summary of Significant Accounting Policies - Schedule of Earned Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Total revenues	$ 450,235	$ 359,978	$ 1,341,924	$ 1,071,450
Premium
Disaggregation of Revenue [Line Items]
Total revenues	417,867	345,415	1,242,311	1,027,400
Capitation
Disaggregation of Revenue [Line Items]
Total revenues	$ 32,368	$ 14,563	$ 99,613	$ 44,050

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- 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
-Topic 924
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479941/924-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 5
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-5

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-30

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
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-Section 50
-Paragraph 4
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-4

+ Details

Commitments and Contingencies

9 Months Ended

Sep. 30, 2023

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.

On April 27, 2022, a former employee of the Company filed a purported class action lawsuit (Dabney v. Alignment Healthcare USA, LLC, Orange County Superior Court) alleging that the Company failed to provide hourly employees with required meal and rest breaks or pay such workers a premium equal to an hour of pay for missed meal or rest breaks. Discovery in the matter commenced on June 8, 2022. On September 2, 2022, the court granted a stay of proceedings and discovery in anticipation of mediation scheduled for August 2023. On August 15, 2023, the Company entered into a tentative settlement of the action in consideration of an aggregate payment of $912,500. The settlement of this matter is subject to approval by the court which is expected in the first quarter of 2024. As a result of the tentative settlement, the Company has accrued for a potential liability of $912,500 as of September 30, 2023 for this matter, which was recorded within accounts payable and accrued expenses on the condensed consolidated balance sheet and selling, general and administrative expenses on the condensed consolidated statement of operations.

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 condensed consolidated financial statements. Amounts accrued for legal proceedings were not material as of September 30, 2023 and December 31, 2022.

Equity-Based Compensation (Tables)

9 Months Ended

Sep. 30, 2023

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 three and nine months ended September 30, 2023:


	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, 2022		10,603,493		$	16.90		8.30	$	3,519
Options granted		—			—
Options exercised		—			—
Options forfeited / expired		(19,369	)		18.41
Balances as of March 31, 2023		10,584,124		$	16.90		8.05		—
Options granted		—			—
Options exercised		—			—
Options forfeited / expired		(17,595	)		17.94
Balances as of June 30, 2023		10,566,529		$	16.90		7.80		—
Options granted		—			—
Options exercised		—			—
Options forfeited / expired		(294,500	)		16.47
Balances as of September 30, 2023		10,272,029		$	16.91		7.55		—
Vested and Exercisable as of September 30, 2023		4,951,671		$	17.43		7.48		—

Schedule of Equity-Based Compensation Expense of Operation

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


	Three Months Ended September 30,				Nine Months Ended September 30,
(amounts in thousands)	2023		2022		2023		2022
Selling, general and administrative expenses	$	11,836	$	16,775	$	45,159	$	52,082
Medical expenses		1,733		1,912		6,024		6,751
Total equity-based compensation expense	$	13,569	$	18,687	$	51,183	$	58,833

Summary of PSUs Transactions

The following is a summary of PSU transactions for the three and nine months ended September 30, 2023:


	Performance-based restricted stock units		Weighted-Average Grant Date Fair Value
Unvested and outstanding as of June 30, 2023		—	$	—
Granted		5,564,005		5.74
Vested		—		—
Cancelled/forfeited		—		—
Unvested and outstanding as of September 30, 2023		5,564,005	$	5.74

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 and nine months ended September 30, 2023:


	Restricted Shares			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2022		4,690,441		$	10.85
Vested		(2,083,984	)		15.89
Forfeited		(9,514	)		9.27
Unvested and outstanding as of March 31, 2023		2,596,943		$	6.81
Vested		(89,370	)		9.42
Forfeited		(5,708	)		9.27
Unvested and outstanding as of June 30, 2023		2,501,865		$	6.71
Vested		(1,503,672	)		7.15
Forfeited		(20,375	)		2.49
Unvested and outstanding as of September 30, 2023		977,818		$	6.13

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 and nine months ended September 30, 2023:


	Restricted Stock Units			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2022		8,728,936		$	13.93
Granted		2,549,551			6.97
Vested		(1,204,777	)		11.95
Cancelled/forfeited		(68,865	)		13.18
Unvested and outstanding as of March 31, 2023		10,004,845		$	12.40
Granted		244,349			7.06
Vested		(43,195	)		10.52
Cancelled/forfeited		(60,406	)		10.71
Unvested and outstanding as of June 30, 2023		10,145,593		$	12.29
Granted		1,034,421			5.75
Vested		(419,130	)		14.72
Cancelled/forfeited		(183,355	)		11.53
Unvested and outstanding as of September 30, 2023		10,577,529		$	11.57

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Long-Term Debt - Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
Long-term debt	$ 165,000	$ 165,000
Less unamortized debt issuance costs	(3,405)	(4,098)
Long-term debt-net of amortization	161,595	160,902
Less current portion of long-term debt	0	0
Long-term debt - net of current portion	$ 161,595	$ 160,902

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Summary of Significant Accounting Policies - Additional Information (Details) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) Entity Segment	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Accounting Policies [Line Items]
Number of consolidated variable interest entities \| Entity			3
Number of reporting segments \| Segment			1
Number of operating segments \| Segment			1
Assets, fair value disclosure	$ 127,058		$ 127,058		$ 2,860
Net loss attributable to noncontrolling interest	30	$ 0	134	$ 0
Federal deposit insurance corporation premium expense			$ 390,047		408,047
Award requisite service period			4 years
Revenues	450,235	359,978	$ 1,341,924	1,071,450
Interest income earned	5,523	29	13,967	37
Deferred premium revenue	146,342		146,342		308
Level 3
Accounting Policies [Line Items]
Assets, fair value disclosure	0		0		0
Liabilities, fair value disclosure	0		0		$ 0
Directly from CMS
Accounting Policies [Line Items]
Revenues	$ 30,476	$ 12,341	$ 92,703	$ 37,753
Medicare Advantage Plan
Accounting Policies [Line Items]
Percentage of consumer discounts on brand name			75.00%
Medicare Advantage Plan \| Minimum
Accounting Policies [Line Items]
Loss ratio			85.00%

Equity-Based Compensation - Summary of PSUs Transactions (Details) - Performance-based Restricted Stock Units	3 Months Ended
	Sep. 30, 2023 $ / shares shares
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Granted \| shares	5,564,005
Unvested and Outstanding, Ending Balance \| shares	5,564,005
Weighted-Average Grant Date Fair Value, Granted \| $ / shares	$ 5.74
Weighted-Average Grant Date Fair Value, Ending Balance \| $ / shares	$ 5.74

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Accounts Receivable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Credit loss related to accounts receivable	$ 40	$ 39	$ 91	$ 150

Equity-Based Compensation - Schedule of Equity-based Compensation Expense on Statement of Operations (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 13,569	$ 18,687	$ 51,183	$ 58,833
Selling, General and Administrative Expenses
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	11,836	16,775	45,159	52,082
Medical Expenses
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 1,733	$ 1,912	$ 6,024	$ 6,751

Medical Expenses Payable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023
Insurance [Abstract]
Claims reserve estimates, excluding provision	$ 2,929	$ 5,784
Remaining claim amounts payment period		3 years

Goodwill and Intangible Assets (Tables)

9 Months Ended

Sep. 30, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets

Intangible assets consisted of the following as of September 30, 2023 and December 31, 2022:


	September 30, 2023
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	34,826	$	—		$	34,826	—
License (indefinite lived)		4,967		—			4,967	—
Plan member relationships		2,700		(2,700	)		—	9 years
Other		1,050		(737	)		313	2 - 10 years
Total	$	43,543	$	(3,437	)	$	40,106


	December 31, 2022
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	34,810	$	—		$	34,810	—
License (indefinite lived)		4,967		—			4,967	—
Plan member relationships		2,700		(2,585	)		115	9 years
Other		1,050		(654	)		396	2 - 10 years
Total	$	43,527	$	(3,239	)	$	40,288

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 2023	$	28
2024		82
2025		60
2026		60
2027		60
Thereafter		23
	$	313

Long-Term Debt - Additional Information (Details) - USD ($) $ in Thousands				3 Months Ended		9 Months Ended
	Jul. 01, 2024	Jun. 30, 2024	Sep. 02, 2022	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Debt Instrument [Line Items]
Long-term debt				$ 165,000		$ 165,000		$ 165,000
Loss on extinguishment of debt				$ 0	$ 2,196	0	$ 2,196
Additional debt issuance costs						0	4,601
Issuance of long-term debt						$ 0	$ 165,000
Oxford Term Loan
Debt Instrument [Line Items]
Long-term debt			$ 165,000
Commitment fee			$ 1,650
Term loan facility maturity date			Sep. 01, 2027
Debt instrument, face amount			$ 250,000
Debt interest floor rate			6.50%
Additional term loan amount			$ 85,000
Term loan issuance date			Sep. 02, 2022
Debt instrument description			Interest on the Term Loans is a variable rate equal to (i) the secured overnight financing rate ("SOFR") administered by the Federal Reserve Bank of New York for a one-month tenor, subject to a floor of 1.00%, plus (ii) an applicable margin of 6.50%. All unpaid principal and accrued and unpaid interest with respect to each Term Loan is due and payable in full on September 1, 2027. The interest rate applied during the quarter ended September 30, 2023 ranged from 11.64% to 11.83%.
Debt instrument orgination fee			$ 1,650
Minimum liquidity in the loan agreement			$ 23,000
Accrual interest rate on default				2.00%		2.00%
Repayment Limit On Net Proceeds From Sale Of Asset						$ 2,500
Oxford Term Loan \| Base Rate
Debt Instrument [Line Items]
Debt interest floor rate			1.00%
Oxford Term Loan \| Maximum
Debt Instrument [Line Items]
Prepayment fee			2.00%
Interest rate during period				11.83%
Oxford Term Loan \| Minimum
Debt Instrument [Line Items]
Prepayment fee			1.00%
Interest rate during period				11.64%
Delayed Draw Term Loan
Debt Instrument [Line Items]
Commitment fee			$ 850
Additional debt issuance costs			$ 1,096
Delayed Draw Term Loan \| Scenario Forecast
Debt Instrument [Line Items]
Issuance of long-term debt	$ 35,000	$ 50,000

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenues:
Earned premiums	$ 450,235	$ 359,978	$ 1,341,924	$ 1,071,450
Other	6,474	370	16,319	898
Total revenues	$ 456,709	$ 360,348	$ 1,358,243	$ 1,072,348
Revenue, Product and Service [Extensible List]	us-gaap:FinancialServiceMember	us-gaap:FinancialServiceMember	us-gaap:FinancialServiceMember	us-gaap:FinancialServiceMember
Expenses:
Medical expenses	$ 397,879	$ 312,850	$ 1,204,838	$ 923,877
Selling, general, and administrative expenses	83,089	76,452	223,696	212,418
Depreciation and amortization	5,497	4,456	15,613	12,586
Total expenses	486,465	393,758	1,444,147	1,148,881
Loss from operations	(29,756)	(33,410)	(85,904)	(76,533)
Other expenses:
Interest expense	5,466	4,605	15,747	13,496
Other expenses (income)	(145)	(131)	(711)	252
Loss on extinguishment of debt	0	2,196	0	2,196
Total other expenses	5,321	6,670	15,036	15,944
Loss before income taxes	(35,077)	(40,080)	(100,940)	(92,477)
Provision for income taxes	0	167	2	167
Net loss	(35,077)	(40,247)	(100,942)	(92,644)
Less: Net loss attributable to noncontrolling interest	30	0	134	0
Net loss attributable to Alignment Healthcare, Inc.	$ (35,047)	$ (40,247)	$ (100,808)	$ (92,644)
Total weighted-average common shares outstanding - basic	187,328,318	182,123,363	185,493,345	180,765,300
Total weighted-average common shares outstanding - diluted	187,328,318	182,123,363	185,493,345	180,765,300
Net loss per share - basic	$ (0.19)	$ (0.22)	$ (0.54)	$ (0.51)
Net loss per share - diluted	$ (0.19)	$ (0.22)	$ (0.54)	$ (0.51)

Goodwill and Intangible Assets - Schedule of Estimated Amortization Expense Related to Intangible Assets (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2023	$ 28
2024	82
2025	60
2026	60
2027	60
Thereafter	23
Estimated Amortization Expense Related to Intangible Assets, Total	$ 313

Long-Term Debt

9 Months Ended

Sep. 30, 2023

Debt Disclosure [Abstract]

Long-Term Debt

8. Long-Term Debt


	September 30, 2023			December 31, 2022
Long-term debt	$	165,000		$	165,000
Less unamortized debt issuance costs		(3,405	)		(4,098	)
Long-term debt-net of amortization		161,595			160,902
Less current portion of long-term debt		—			—
Long-term debt - net of current portion	$	161,595		$	160,902

Oxford Term Loan

On September 2, 2022 (the "Effective Date"), we entered into a senior secured term loan agreement (the “Oxford Loan Agreement”) with Oxford Finance LLC (“Oxford”), as administrative agent, collateral agent and a lender, and the other lenders from time to time party thereto (collectively, the “Lenders”), pursuant to which the Lenders have agreed to lend an aggregate principal amount of up to $250,000 in a series of term loans (the “Term Loans”). Pursuant to the Oxford Loan Agreement, we received an initial Term Loan of $165,000 on the Effective Date and may borrow up to an additional $85,000 of Term Loans at our option (such additional Term Loans, the “Delayed Draw Term Loans”). Interest on the Term Loans is a variable rate equal to (i) the secured overnight financing rate ("SOFR") administered by the Federal Reserve Bank of New York for a one-month tenor, subject to a floor of 1.00%, plus (ii) an applicable margin of 6.50%. All unpaid principal and accrued and unpaid interest with respect to each Term Loan is due and payable in full on September 1, 2027. The interest rate applied during the quarter ended September 30, 2023 ranged from 11.64% to 11.83%.

The aggregate proceeds of the Delayed Draw Term Loans drawn on or prior to June 30, 2024 may not exceed $50,000 unless used for permitted acquisitions and may not exceed $35,000 drawn on or after July 1, 2024.

The term loan was subject to a commitment fee of $1,650 and an origination fee of $1,650. The Delayed Draw Term Loans are subject to a commitment fee of $850. We incurred additional debt issuance costs of $1,096 related to attorney fees and other third-party costs. The commitment and origination fees are included within debt issuance costs and were deferred and will be amortized to interest expense

over the debt term using the straight line method, which is materially consistent with the effective interest method. The debt issuance costs related to the term loan are presented in the condensed consolidated balance sheet as a direct deduction from the carrying value of the term loan. The debt issuance costs related to the delayed draw term loan are presented in the condensed consolidated balance sheet as other assets.

The Term Loans are guaranteed by certain of our wholly owned subsidiaries and collateralized by all unrestricted assets.

For certain prepayments of the Term Loans prior to the second anniversary of the Effective Date, we will be required to pay a prepayment fee ranging from 1.00% to 2.00% of the principal amount of the Term Loans being prepaid.

The Oxford Loan Agreement includes customary events of default, including, among others, payment defaults, breach of representations and warranties, covenant defaults, judgment defaults, insolvency and bankruptcy defaults, and change of control. The occurrence of an event of default could result in the acceleration of the obligations under the Oxford Loan Agreement, termination of the Term Loan commitments and the right to foreclose on the collateral securing the obligations. During the existence of an event of default, the outstanding Term Loans will accrue interest at a rate per annum equal to 2.00% plus the otherwise applicable interest rate. Additionally, in the event of any contemplated asset sale or series of asset sales yielding net proceeds in excess of $2,500, except those excluded per the Oxford Loan Agreement, we are required to prepay the aggregate outstanding principal balance of the Term Loans in an amount equal to the entire amount of the asset sale net proceeds, plus any accrued and unpaid interest.

The Oxford Loan Agreement includes financial covenants that require the Borrower Parties to (i) maintain minimum liquidity, as defined in the Loan Agreement, of $23.0 million and (ii) satisfy a maximum permitted ratio of debt to trailing twelve-month revenue, as set forth in the Loan Agreement. As of September 30, 2023 and December 31, 2022, we were in compliance with the Oxford financial covenants.

Future maturities under the term loan as of September 30, 2023 are as follows:


Period Ending September 30,	Amount
2023	$	—
2024		—
2025		1,650
2026		1,650
2027		161,700
	$	165,000

Accounts Receivable - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Government receivables	$ 29,367	$ 33,200
Pharmacy rebate receivables	72,558	54,605
Other receivables	3,689	5,085
Total accounts receivable	105,614	92,890
Allowance for credit losses	(91)	0
Accounts receivable, net	$ 105,523	$ 92,890

Equity-Based Compensation - Summary of RSUs Transactions (Details) - Restricted Stock Units - $ / shares	3 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Unvested and Outstanding, Beginning Balance	10,145,593	10,004,845	8,728,936
Granted	1,034,421	244,349	2,549,551
Vested	(419,130)	(43,195)	(1,204,777)
Cancelled/forfeited	(183,355)	(60,406)	(68,865)
Unvested and Outstanding, Ending Balance	10,577,529	10,145,593	10,004,845
Weighted-Average Grant Date Fair Value, Beginning Balance	$ 12.29	$ 12.4	$ 13.93
Weighted-Average Grant Date Fair Value, Granted	5.75	7.06	6.97
Weighted-Average Grant Date Fair Value, Vested	14.72	10.52	11.95
Weighted-Average Grant Date Fair Value, Cancelled/Forfeited	11.53	10.71	13.18
Weighted-Average Grant Date Fair Value, Ending Balance	$ 11.57	$ 12.29	$ 12.4