Making healthcare work like a market — the cash-price insurer examined from its public filings. Model, incentives, traction, and the complete statutory financial record FY2021–FY2025.
Financial figures are statutory (NAIC SAP) amounts as filed by Sidecar Health Insurance Company (NAIC 17104, domiciled in Ohio) with the Ohio Department of Insurance (Annual Statements FY2021–FY2025, quarterly statements) and the Florida Office of Insurance Regulation (Consent Order, 30 Apr 2025). Statutory accounting differs from GAAP. Parent-level figures (valuations, rounds) are from PitchBook, Forge and company announcements. Cells marked “(d)” are arithmetic combinations of filed lines. Company-reported operating metrics (81% / 21% / <1% / cash back) are management's statements from testimony and interviews, not independently audited. Verify against the original filings — every source URL is in Appendix B.
Employer health costs keep rising, prices stay hidden, and the network contract — the industry's core cost-control tool — has stopped containing either.
Annual US employer-sponsored health spend — roughly half of all Americans are covered through an employer
Employer premium increases in the most recent renewal cycle (WSJ, cited by Sidecar's CEO)
Share of in-network claims denied by traditional ACA plans (KFF analysis); large insurers' own rebuttal conceded ~10%
1. Shift cost to employees. Higher deductibles and out-of-pocket maximums transfer the increase to households — high-deductible plans are now the norm, not the exception.
2. Narrow the network. Fewer hospitals and doctors in-network reduces unit prices but restricts access and produces surprise bills when members stray outside it.
Both responses manage the symptom — the premium — while leaving the underlying price-setting mechanism untouched.
The ACA individual segment — where Sidecar started — swung to a $5.5B industry underwriting loss in 2025 (medical ratios averaging 93.2%) as enhanced subsidies expired and morbidity worsened.
Only ~6% of Americans buy individual coverage. The economic mass — and the affordability crisis — sits in employer-sponsored insurance, which is why Sidecar now sells to employers only.
Negotiated rates are contractual secrets. Members cannot compare providers ex ante; bills arrive weeks later; deductibles convert every interaction into an unknown liability. Demand cannot respond to a signal it never sees.
With no functioning marketplace, expensive care is not better care — Sidecar's data shows a slightly negative price–quality correlation. Patients assume the opposite and overpay for routine care.
The network's original purpose was price discipline. Its modern function is access control — prior authorisation, formularies, step therapy — while negotiated rates drift upward with consolidated hospital systems.
Two-week wait. A gatekept CT scan first. Prior authorisation. A surprise bill inside the deductible. “I didn't know it was going to be $1,300 — but it was my responsibility to pay it.”
“I can get you in tonight.” No wait, no CT detour, no authorisation, no surprise — payment by Visa at the desk. Same machine. Same team. 75% less.
Patrick Quigley — an engineer and consumer-internet operator, not a healthcare insider — took the result to co-founder Veronica Osetinsky the next morning: paying the provider directly was faster, skipped procedures the insurance process had demanded, and cost a quarter of the network price. The 2018 company was built on a single design principle: let people treat healthcare dollars like their own — with the information, and the incentive, to act on them. The sceptics included his own father, a surgeon (“you can't pay doctors directly”) and a healthcare VC who told him to first “build a better search engine than Google.” Both objections — provider acceptance and data complexity — became the engineering agenda.
Source: Bright Spots in Healthcare interview, Feb 2026 (transcript on file)
~170,000 services and drugs carry a Benefit Amount set at the midpoint of local commercial rates — the mid-priced provider in each market.
The app shows every US doctor's estimated price plus outcome-based quality scores (GAM, a Johns Hopkins spin-out). Any licensed provider; no referrals; no prior authorisation.
The member pays with a Sidecar-issued Visa card. Coverage is validated in real time; the provider is paid in full, immediately — no claim forms.
Below the Benefit Amount: the member keeps half the difference, accruing in their account. Above it: a known, guaranteed gap. No surprise bills, ever.
| Choice | Provider price | Member outcome | Plan outcome |
|---|---|---|---|
| Doctor at the market's Benefit Amount | $100 | Nothing owed | Pays $100 |
| Premium doctor, member's preference | $150 | Pays a known $50 gap | Pays $100 |
| Efficient doctor, 10 min away | $75 | Earns $12.50 (half of $25) | Pays $87.50, saves $12.50 |
The displayed price is a locked-in guarantee: if the provider's actual charge differs from the estimate, the member's position is unchanged — the plan absorbs the estimation error and updates its data for everyone else. Average cash back: ~$1,000 per family per year (company-reported).
You get what you incentivise. The design rewires all three parties at once — transparency supplies the information, but the shared-savings rule supplies the motive. Information without motive is a brochure.
| Party | Old incentive | Sidecar incentive | Observed behaviour |
|---|---|---|---|
| Member | Insulated from price; rationed by deductibles, prior auth and denial risk | Keeps 50% of savings below the Benefit Amount; guaranteed price before treatment; no barriers | More primary care and mental-health use; 75–80% of prescriptions moved to low-cost pharmacies; less ER use; ~$1,000/family annual cash back |
| Provider | Bills into a network contract; waits months for payment; carries collection cost | Paid in full, instantly, at point of sale — cash price, no contract, no billing overhead | Accepts direct pay at commercial-rate midpoints; competes on published price and quality for the first time |
| Employer | Chooses between cost-shifting to staff and narrowing the network each renewal | Buys a plan priced ~20% below comparable coverage; employee shopping lowers claims directly | Early adopters are employers with the sickest populations — they face the steepest legacy renewal increases |
We've known for decades that consumer-driven healthcare is the path — that is why HSAs exist. We simply stopped short of putting the incentives and transparency in place to make it work. Sidecar is the first to do it at health-plan scale.
of claims land at or below the Benefit Amount — members earn money on the majority of interactions (Texas House testimony, 1 Sep 2026)
lower total medical costs than network-based plans; Sidecar commits to 20% premium savings, with third-party studies reportedly higher
clinical denial rate, versus 19% in-network denials for traditional ACA plans (KFF) — and insurers' own rebuttal of ~10%
average annual cash back per family from choosing care below the Benefit Amount
of members now fill prescriptions at low-cost pharmacies — identical drugs, different prices, incentive attached
than average is how the CEO describes the insured population — high-cost groups move first because their legacy increases are largest
| Year | Move | Logic |
|---|---|---|
| 2019 | Access Plan (excepted benefit), Texas first | Prove the cash-price thesis with a simple supplemental product |
| 2021 | Own carrier established in Ohio; ACA individual plans | Full-stack control: underwriting, pricing and payment rails in-house |
| 2022 | Fully insured large-group (51+) launches in Ohio | The employer market is where the premium mass is |
| 2023–24 | Georgia, then Florida; individual line exited at end-2023 | Individual = ~6% of Americans; employers = ~50% and >$1T of spend |
| 2025–26 | ASO for self-funded jumbo employers; Texas entry Jan 2026 | ASO needs no state-by-state licence ladder — national reach at once |
The filings confirm a clean break: the FY2025 premium exhibit shows $0 individual premium; the book is 100% comprehensive group. The Ohio individual book still appears in CMS risk-adjustment reporting (BY2023 default charge $(632,857)) — evidence it operated inside the full ACA apparatus before leaving it.
State-licensed product; the carrier bears the risk. Live in Ohio (2022), Georgia (2023), Florida (2024), Texas (Jan 2026). Premium flows onto the statutory book — this is the $83.9M FY2025 premium line. Growth is gated state-by-state by regulators.
Administered by affiliate Sidecar Health Insurance Solutions, LLC; the employer keeps the risk. National reach immediately — members in 46 states. Anchor account: a segment of Koch Industries' ~100,000 covered lives, from 2025. Fee income, not premium — capital-light scaling.
Investor lens: two channels = one engine monetised twice (risk-bearing premium + capital-light fees). Government lens: ASO reaches workers in states where Sidecar holds no licence, under federal ERISA self-funding rules. Employer-sponsored insurance covers ~155M Americans; ~60% of covered workers sit in self-funded arrangements reachable through ASO.
As filed, Exhibit 1 and five-year historical data. Member months: 0 → 6,397 → 53,521 → 104,872 → 182,737. FY2025 premium of $459 PMPM (derived), up from $352 in 2023 — richer employer mix. ~242 staff (PitchBook, 2025), split ~50/50 consumer-industry and healthcare operators per the CEO.
Koch Disruptive Technologies led the June 2024 Series D ($165M) — described as the largest private investment in employer health benefits that year.
Koch Industries adopted Sidecar for a segment of its 100,000+-life workforce from 2025 — the largest proof that the model works at enterprise scale.
Koch shaped the jumbo self-funded product launched nationally in 2025 — a referenceable blueprint for other 100,000-life employers.
| Jurisdiction | Status |
|---|---|
| Ohio (domicile) | Carrier established 2021; NAIC 17104 |
| Georgia | Certificate of Authority 2023 |
| Florida | Certificate of Authority 4 Apr 2023 |
| Texas | Approved to sell/administer large-employer plans, Jan 2026 |
Five states licensed in the FY2025 Schedule T — consistent with a deliberate four-state fully insured strategy plus the licence-free ASO channel.
Florida Consent Order (30 Apr 2025). Premium capped at filed projections — $1.26M (2024), $36.86M (2025), $94.58M (2026); all projected net losses pre-funded by the parent; quarterly re-projection with a 45-day cure; relief only after two consecutive profitable annual statements.
Texas House testimony (1 Sep 2026). The CEO was invited to testify before the Select Committee on Health Care Affordability — created to support the Governor's 20% cost-reduction target. A regulatory relationship shifting from supervised to consultative.
Every figure in this section is from the NAIC Annual and Quarterly Statements of Sidecar Health Insurance Company filed with the Ohio Department of Insurance, unless marked (d) for derived.
RBC ratio YE2025 (TAC $23.7M vs ACL $4.5M)
Cumulative contributed surplus from parent to YE2025
FY2025 medical loss ratio — claims alone exceed premium
Cumulative statutory net losses, FY2021–FY2025
| US$ | Line | FY2025 | FY2024 |
|---|---|---|---|
| Member months | 1 | 182,737 | 104,872 |
| Net premium income | 2 | 83,928,524 | 44,727,753 |
| Other revenue lines (change in UPR, fee-for-service, risk revenue, write-ins) | 3–7 | — | — |
| Total revenues | 8 | 83,928,524 | 44,727,753 |
| Hospital/medical benefits; other professional services | 9–10 | — | — |
| Outside referrals | 11 | 51,673,616 | 15,529,983 |
| Emergency room and out-of-area | 12 | 12,601,815 | 17,944,871 |
| Prescription drugs | 13 | 27,377,866 | 16,858,183 |
| Other hospital/medical & incentive pools | 14–15 | — | — |
| Subtotal — hospital and medical, gross | 16 | 91,653,297 | 50,333,038 |
| Less: net reinsurance recoveries | 17 | (5,840,010) | (3,451,926) |
| Total hospital and medical, net | 18 | 85,813,287 | 46,881,111 |
| Claims adjustment expenses (incl. $553,247 cost containment) | 20 | 7,498,183 | 5,141,536 |
| General administrative expenses | 21 | 6,847,771 | 5,681,581 |
| Increase in A&H contract reserves | 22 | 917,346 | (1,157,086) |
| Total underwriting deductions | 23 | 101,076,587 | 56,547,143 |
| Net underwriting gain (loss) | 24 | (17,148,063) | (11,819,390) |
| Net investment gain | 27 | 1,061,888 | 501,402 |
| Other income / federal income tax | 28–31 | — | — |
| Net income (loss) | 32 | (16,086,174) | (11,317,989) |
| 2021 | 2022 | 2023 | 2024 | 2025 | |
|---|---|---|---|---|---|
| Net premium income | 0 | 1,372,050 (d) | 18,815,070 | 44,727,753 | 83,928,524 |
| Total underwriting deductions | 93,112 | 5,229,346 | 23,906,717 (d) | 56,547,143 | 101,076,587 |
| Net underwriting gain (loss) | (93,112) | (3,857,296) | (5,091,647) | (11,819,390) | (17,148,063) |
| Net investment gain (loss) | (5,930) | 85,232 | 165,426 | 501,402 | 1,061,888 |
| Net income (loss) | (99,042) | (3,772,064) | (4,926,221) | (11,317,989) | (16,086,174) |
| Net cash from operations | 10,214 | (232,749) | 1,253,879 | (12,428,851) | (14,192,261) |
| Members at year-end | 0 | 1,475 | 5,706 | 7,910 | 16,297 |
| Member months | 0 | 6,397 | 53,521 | 104,872 | 182,737 |
| Premium per member-month (d) | — | $214 | $352 | $427 | $459 |
The shape of the story: revenue has compounded from zero to $83.9M in four selling years, with premium PMPM rising each year as the mix shifted to large-group business. Losses widened in absolute dollars alongside — every expansion year (Georgia 2023, Florida 2024, ASO/Texas 2025) shows in the loss line. Underwriting margin: −281% (2022) → −27.1% (2023) → −26.4% (2024) → −20.4% (2025). The ratio is improving even as the absolute loss grows.
| 2021 | 2022 | 2023 | 2024 | 2025 | |
|---|---|---|---|---|---|
| Medical loss ratio (hospital & medical, net) | 0.0 | 167.3 | 96.5 | 104.8 | 102.2 |
| Cost containment expenses | 0.0 | 3.4 | 0.2 | 0.0 | 0.7 |
| Other claims adjustment expenses | 0.0 | 23.0 | 14.6 | 11.5 | 8.3 |
| General administrative (d) | — | 126.9 | ~18 (d) | 12.7 | 8.2 |
| Underwriting margin (d) | — | (281.2) | (27.1) | (26.4) | (20.4) |
| 2025 | 2024 | |
|---|---|---|
| Bonds (Schedule D) | 22,329,622 | 15,843,500 |
| Cash, cash equivalents & short-term | 20,868,293 | 9,781,982 |
| Subtotal, cash and invested assets | 43,197,915 | 25,625,482 |
| Investment income due and accrued | 180,787 | 121,210 |
| Uncollected premiums (net of nonadmitted) | 1,836,947 | 1,536,403 |
| Member Visa-card receivables | 5,425,493 | 2,937,802 |
| Health care & other receivables (nonadmitted) | 726,439 | 519,093 |
| Other assets / write-ins (d) | 685,000 (d) | 2,197,000 (d) |
| Nonadmitted assets (excluded above) | 1,084,508 | 717,728 |
| Total admitted assets | 52,052,301 | 32,937,178 |
| 2025 | 2024 | |
|---|---|---|
| Claims unpaid — IBNR reserves (Note 25) | 13,732,131 | 13,288,976 |
| Loss adjustment expense reserves | 500,819 | 513,024 |
| Premium deficiency reserve (Note 30) | 1,087,729 | — |
| Reinsurance premiums payable (Note 23) | 1,017,034 | — |
| Payable to parent & affiliates (Note 10) | 2,128,494 | 1,004,603 |
| Excess-benefit liability & other (d) | 9,872,000 (d) | 6,463,000 (d) |
| Total liabilities (d) | 28,338,300 | 21,270,200 |
| Common stock ($100 par, 30,000 shares) | 3,000,000 | 3,000,000 |
| Gross paid-in & contributed surplus / unassigned | 58.0M / (37.3M) (d) | 29.5M / (20.8M) (d) |
| Total capital & surplus | 23,714,001 | 11,666,956 |
“Excess-benefit liability & other” includes the member cash-back liability described in Note 1C (Benefit Amounts exceeding Visa-card charges are retained as a liability on the member's behalf). Investments are investment-grade bonds and cash managed by AAM, custodied at Fifth Third; $121K on deposit with the Ohio DOI.
at 1 Jan 2025
FY2025 operations
change, charged to surplus
cash from parent in 2025
at 31 Dec 2025
| FY2025 | FY2024 | |
|---|---|---|
| Premiums collected, net of reinsurance | 85,337,535 | 41,693,352 |
| Net investment income collected | 948,673 | 427,365 |
| Total cash in | 86,286,207 | 42,120,718 |
| Benefit and loss-related payments | (86,030,326) | (44,729,432) |
| Commissions, expenses & other deductions | (14,448,142) | (9,820,137) |
| Net cash from operations | (14,192,261) | (12,428,851) |
| Net cash from investments | (6,432,483) | (9,671,336) |
| Capital & paid-in surplus received | 28,500,000 | 16,500,000 |
| Other financing sources | 3,211,055 | 3,450,300 |
| Net cash from financing | 31,711,055 | 19,950,300 |
| Net change in cash & equivalents | 11,086,311 | (2,149,887) |
| Cash, cash equivalents & short-term, year-end | 20,868,293 | 9,781,982 |
Operations consumed $14.2M of cash in FY2025 — cash burn tracks the accounting loss closely. The parent's $28.5M injection more than doubled the burn; the year's cash build ($11.1M) is entirely a financing outcome. Benefit payments of $86.0M against $85.3M collected premium — a cash medical ratio of ~101%.
| Year-end | Total adj. capital | ACL RBC | Ratio |
|---|---|---|---|
| 2021 | 9,899,958 | 27,860 | n/m |
| 2022 | 5,704,762 | 901,247 | 633% |
| 2023 | 6,886,883 | 1,355,080 | 508% |
| 2024 | 11,666,956 | 2,833,130 | 412% |
| 2025 | 23,714,001 | 4,535,919 | 523% |
| Lever | Mechanism | Evidence in the filings |
|---|---|---|
| Medical ratio normalisation | MLR must fall from 102% toward the mid-80s as pricing seasons, the captive retains economics, and shopping behaviour compounds | MLR path 167% → 96.5% → 102% is noisy, not linear; FY2025 favourable development $13.2M |
| Operating leverage | Claims-adjustment + G&A fell from 35.7% to 16.5% of premium in three years | Filed ratio trend, five-year data |
| ASO fee income | National jumbo-employer fees with no carrier capital at risk | ASO runs through affiliate SHIS (TPA fees $39.70/enrollee/month disclosed) |
| Investment income | Growing float in bonds and cash | Investment gain ×21 since 2022, to $1.06M in FY2025 |
The public milestone: Florida's consent order sets an objective, externally monitored definition of success — two consecutive annual statements with positive net income release the pre-funding covenant and the premium caps. The FY2026 statement (due March 2027) is the first reading of whether the model's economics catch up with its growth; Florida alone permits up to $94.6M of premium in 2026.
Prices for every US doctor, assembled from machine-readable transparency files (post-2021 federal rules), purchased commercial claims data, and AI estimation — coverage no incumbent publishes.
Every member transaction is a price-discovery event. Wrong estimates cost the plan money once — then the map updates for everyone. The dataset compounds with membership; a copier starts cold.
Real-time coverage validation at the Visa swipe; locked-in pricing guarantees; instant provider settlement. “We made it simple — and that is hard.”
Copying Sidecar requires a legacy carrier to publish prices that expose its own rate dispersion, surrender network leverage — its primary asset — and rebuild claims as a real-time payments business. Each step cannibalises the existing book. The CEO's stated fear is a large technology company entering from the consumer side; his counter is that the model cannot be built by incrementing inside the old constraints. The regulatory footprint is the quiet moat: four state licences, a consent-order track record, a captive, and actuarial leadership from former Blue Cross chief actuaries — two to three years of lead time for a new entrant.
| Legacy carriers (UHC, Elevance, Aetna, Cigna, Blues) | VC insurtechs (Oscar, Clover, Devoted) | Sidecar Health | |
|---|---|---|---|
| Core mechanism | Network negotiation + utilisation management | Tech layer on top of network insurance (mostly MA / ACA) | Published Benefit Amounts + direct point-of-sale payment; no network at all |
| Member price visibility | After the fact, via EOB | Partial, in-network | Upfront, guaranteed, every US provider |
| Incentive design | Deductibles and cost-shifting | Care navigation within network | Member keeps 50% of savings — paid to shop |
| Overlap with Sidecar | Every renewal — but structurally unable to copy without cannibalising the network | Different segments; Sidecar exited those markets | Employer group medical, fully insured and ASO |
The honest competitive risk is a big-tech entrant with consumer distribution, and reference-based-pricing administrators who offer employers similar price logic without an insurance licence. Sidecar's answer: it is the only licensed, regulated, risk-bearing carrier with the payment rail built in.
| Executive | Role | Background |
|---|---|---|
| Patrick Quigley | Co-founder & CEO | CEO of Katch (insurance customer acquisition), QuinStreet founding team, ex-McKinsey; engineer by training |
| Veronica Osetinsky | Co-founder & COO | Ex-Katch, QuinStreet; fixed-income banking (BofA) and a $2B securitised-products fund at Paramax; UC Berkeley economics |
| Douglas Lynch | Chief Actuary | Former chief actuary at HCSC and Florida Blue; signs the statutory actuarial opinion |
| Stuart Battersby | Chief Financial Officer | Capital, reinsurance and regulator-facing financial management |
| Natalie Leino | GC / Chief Compliance & Risk Officer; Secretary of the carrier | Formerly General Counsel of Carelon Behavioral Health (Elevance Health) |
| Alex Coonce · Kevin Knight · Rodney Barlow | Chief People Officer · CMO · CTO | Team deliberately split ~50/50 consumer-industry and healthcare operators |
Governance: the subsidiary holds its own audit committee (filed general interrogatories); Fifth Third as custodian; AAM for investment management. Investor register: Koch Disruptive Technologies, Drive Capital, Tiger Global, BOND, Menlo Ventures, GreatPoint, Cathay Innovation, Morpheus, Alpha Edison, Duke University.
| Round | Date | Amount | Lead / notable investors | Valuation context |
|---|---|---|---|---|
| Series A | 2018 | $7.5M | GreatPoint Ventures, Morpheus | Seed-stage thesis capital |
| Series B / B-1 | 2019–20 | $50M | Cathay Innovation; Anne Wojcicki, Comcast Ventures, Kauffman Fellows | Access Plan era |
| Series C | Jan 2021 | $125M | Drive Capital, Tiger Global, BOND, Menlo | $1.0B post-money — unicorn |
| Series D | Jun 2024 | $165M | Koch Disruptive Technologies (also anchor customer) | ~$668M post-money (Forge) — a reset vs Series C |
| Venture debt | Jan 2025 | $75M | Undisclosed lender (PitchBook) | Non-dilutive growth capital |
| Parent equity to carrier | 2021–25 | $58M | Contributed surplus, per Note 13 | Losses funded at subsidiary level |
Forge's secondary-market data prices the June 2024 Series D at roughly $668M post-money against a $1.0B Series C — on paper, a down round. Context: the 2021 mark was a consumer-insurtech-era price on an individual-market story; the 2024 round funded a different, larger business (employer group + ASO) with Koch underwriting both the cheque and the flagship account. Total capital raised is approximately $426M including debt ($340M equity); the parent raised a further $32M in Q2 2025 per the carrier's going-concern note. For a Series D+ investor, the entry question is whether the next re-rating comes from the FY2026–27 statutory statements — the pre-funding covenant makes profitability a dated, regulator-observed event rather than a management promise.
Full statutory transparency (NAIC filings, RBC, actuarial opinions, named officers); acceptance of premium caps and loss pre-funding without litigation; a carrier meeting ACA essential-health-benefit standards without network walls; ~$1,000 per family per year returned to working families (company-reported).
1. Neutral treatment of defined-benefit designs in rate/form filing. 2. Equal access to price data — continued enforcement of transparency rules is directly pro-consumer here. 3. Reciprocal supervision: Florida's caps-plus-prefunding template protects policyholders while a new model proves itself — a middle path other states can reuse.
| Risk | Evidence | Mitigant / read-through |
|---|---|---|
| Persistent losses | Cumulative net loss $(36.2)M FY2021–25; MLR 102.2% in FY2025; losses widen with each expansion year | H1 2024 near-breakeven shows a profitable steady state exists; the Florida covenant forces dated accountability; expense ratios already scaling down |
| Valuation reset | Series D (~$668M post, Forge) priced below the $1B Series C | New money entered at the reset with the anchor customer attached; the covenant-defined profitability milestone gives the next mark an objective trigger |
| Regulatory constraint | Florida premium capped through 2026 ($94.6M ceiling); pre-funding of projected losses; other states may impose similar terms | Caps are per-state and renegotiable on performance; ASO channel is uncapped; consent-order compliance builds the expansion file |
| Model risk in pricing data | Benefit Amounts are estimates; member receivables ($5.4M) and card write-offs ($0.4M H1 2025) show operational leakage | Locked-in pricing shifts estimation error to the plan; every error is a one-time cost that improves the dataset |
| Concentration & copycats | One ~100K-life anchor account; the CEO concedes the model will be copied if it works | Koch is also the lead investor — exit costs are high on both sides; pricing-data lead and licences are the time-based moat |
Not shown as mitigated: dependence on continued parent funding (the going-concern note relies on it), adverse-selection risk as sicker groups adopt first, and the possibility that cash-price dispersion narrows — the model's own success compresses the arbitrage it monetises.
Fifteen years from now, every health plan will run on this model. We intend to be the largest of them.
A $1T category with a structurally different cost model, an anchor customer who is also the lead investor, and a regulator-dated path to profitability. The risk is priced in — and disclosed.
A carrier that publishes prices, pays providers instantly, returns savings to families, accepts caps and pre-funding, and shows up when legislatures ask how to cut costs.
The FY2026 annual statement (March 2027): medical ratio, the captive's first year, Texas premium ramp against Florida's $94.6M cap precedent.
| 2025 | 2024 | 2023 | 2022 | 2021 | |
|---|---|---|---|---|---|
| Net premium income (Page 4, Line 2) | 83,928,524 | 44,727,753 | 18,815,070 | 1,372,050 (d) | 0 |
| Total underwriting deductions (Line 23) | 101,076,587 | 56,547,143 | 23,906,717 (d) | 5,229,346 | 93,112 |
| Net underwriting gain (loss) (Line 24) | (17,148,063) | (11,819,390) | (5,091,647) | (3,857,296) | (93,112) |
| Net investment gain (loss) (Line 27) | 1,061,888 | 501,402 | 165,426 | 85,232 | (5,930) |
| Net income (loss) (Line 32) | (16,086,174) | (11,317,989) | (4,926,221) | (3,772,064) | (99,042) |
| Net cash from operations (Page 6) | (14,192,261) | (12,428,851) | 1,253,879 | (232,749) | 10,214 |
| Total adjusted capital | 23,714,001 | 11,666,956 | 6,886,883 | 5,704,762 | 9,899,958 |
| Authorised control level RBC | 4,535,919 | 2,833,130 | 1,355,080 | 901,247 | 27,860 |
| Total members, end of period | 16,297 | 7,910 | 5,706 | 1,475 | 0 |
| Total member months | 182,737 | 104,872 | 53,521 | 6,397 | 0 |
| Medical loss ratio, % of premium | 102.2 | 104.8 | 96.5 | 167.3 | 0.0 |
(d) = derived from filed lines. Total admitted assets: $10,096,916 (2021), $32,937,178 (2024), $52,052,301 (2025).
legacy.insurance.ohio.gov/FRAnnuals/): Annual statements — 2021 /2021/annual/KS/17104A2021KS.pdf · 2022 /2022/annual/KS/17104A2022KS.pdf · 2023 /2023/annual/KS/17104A2023KS.pdf · 2024 /2024/Annual/OS/17104A2024OS.pdf · 2025 /2025/Annual/KS/17104A2025KS.pdf. Quarterly statements: /{YEAR}/{Q1|Q2|Q3}/17104{Q#}{YEAR}.pdf (Q3 2021 – Q3 2025 confirmed). Jurat pages: /{YEAR}/{PERIOD}/Affidavits%20and%20Jurats/17104%20Jurat.pdf. If firewall-blocked, request via Ohio DOI public records — these are public documents.floir.gov/docs-sf/default-source/orders/life-and-health/2025/sidecar-health-insurance-company-consent-order-(04-30-2025).pdfhouse.texas.gov/committees/committee/059)| Term | Meaning in this briefing |
|---|---|
| Benefit Amount | Sidecar's published budget per service/drug, set at the local commercial midpoint; the plan pays it regardless of billed charges; members keep 50% of any underspend |
| NAIC SAP | Statutory accounting prescribed for US insurers — more conservative than GAAP (some assets are “nonadmitted” and excluded from surplus) |
| MLR | Net hospital & medical cost as % of premium; above 100% means claims alone exceed premium |
| IBNR / LAE | Reserves for claims incurred but not reported, and the cost of adjusting them |
| RBC / ACL / TAC | Risk-based capital: TAC is actual capital; ACL is the regulatory intervention floor; the ratio (523% at YE2025) measures the cushion |
| Premium deficiency reserve | Reserve held when future premiums plus reserves are expected to fall short of future claims — an admission that a block is under-priced |
| Quota share / captive | Reinsurance ceding a fixed % of all risk; from 1 Jan 2026 Sidecar cedes 100% to its own affiliated Ohio captive |
| Excess of loss (stop-loss) | Reinsurance paying claims above a per-member attachment point ($200K on the 2023–24 treaty; ~$400K per the CEO) |
| ASO / TPA | Administrative-services-only: affiliate SHIS ($39.70/enrollee/month) runs self-funded employer plans without the carrier taking risk |
| Member months / PMPM | One member covered for one month; premium PMPM = premium ÷ member months (FY2025: $459) |
| Consent order / pre-funding | A regulatory agreement; Florida's requires the parent to deposit capital covering projected losses before they occur, with premium caps through 2026 |