ALHC Alignment Healthcare Inc

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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.

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 balance sheet as of December 31, 2023, included herein, was derived from audited financial statements, but does not include all disclosures required by GAAP. In accordance with the rules and regulations of the U.S. Securities and Exchange Commission ("SEC"), the Company has omitted certain footnote disclosures that would substantially duplicate the disclosures contained in its annual audited consolidated financial statements. Therefore, these condensed consolidated financial statements should be read in conjunction with the Company's Annual Report on Form 10-K for the year-ended December 31, 2023 as filed with the SEC. Furthermore, 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

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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, 2024 and December 31, 2023. 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, 2024 and 2023 were as follows:

			Three Months Ended September 30,												Nine Months Ended September 30,
			2024						2023						2024						2023
Premium			$	683,270					$	417,867					$	1,976,524					$	1,242,311
Capitation			1,226						32,368						3,622						99,613
Total			$	684,496					$	450,235					$	1,980,146					$	1,341,924

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. In 2023, capitation revenue consisted primarily of revenue 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.

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We also participate in the CMS ACO REACH program, formerly the Direct Contracting Model ("DCE"). CMS serves as the claim adjudicator for institutional and specialists care, and directly pays for such fee for service claims. 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. In 2024, we entered into a management services and risk management agreement with a third-party healthcare company. The third party will be responsible for arranging and controlling the health care services provided to the ACO members, and for providing certain management and support services with respect to ACO operations. The third party will also assume specified upside and downside financial risk relative to the ACO’s performance. As a result of this arrangement, revenue is recorded on a net basis within other revenue on the condensed consolidated statement of operations for the three and nine months ended September 30, 2024. Revenue recognized by the ACO for the three and nine months ended September 30, 2024 was $212 and $453, respectively.

Prior to 2024, the ACO acted 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 were determined from an annual benchmark established by CMS. These payments, which were adjusted for variable considerations, represented revenue for providing health care services, including primary care as well as institutional and specialist care. The ACO recognized capitation revenue for providing these services in the period in which the performance obligations were 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.

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, 2024 was $6,649 and $17,694, respectively. Interest income for the three and nine months ended September 30, 2023 was $5,523 and $13,967, 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, 2024 and December 31, 2023.

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

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receivable or payable at the contract level and classify the amount as current or long-term in our condensed consolidated balance sheets 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.

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 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. In 2023, we also recorded claims expenses related to our institutional and specialist care related to our ACO program with CMS as we acted as the principal in the transaction. As discussed above, beginning in 2024, claims expense related to the ACO program is netted against ACO revenue as we act as the agent in these transactions.

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 sheets.

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. There was no material impact on our consolidated financial statements at September 30, 2024, and we do not anticipate a material impact to operations for the remainder of fiscal year 2024. We are in the process of evaluating the impact the IRA will have on our business for fiscal years beyond 2024.

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

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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 sheets. Throughout the year, we evaluate expected losses on risk-sharing receivables and record the resulting expected losses to the

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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, 2024 and December 31, 2023, we recorded an allowance for credit losses 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 sheets.

Concentrations of Credit Risk

Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash deposits and current 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, 2024 and December 31, 2023, there was $379,464 and $316,977, 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 on the date of grant.

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.

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, 2024 and 2023:

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			Three Months Ended September 30,												Nine Months Ended September 30,
			2024						2023						2024						2023
Numerator:
Net loss			$	(26,429)					$	(35,077)					$	(97,007)					$	(100,942)
Less: Net loss attributable to noncontrolling interests			16						30						63						134
Net loss attributable to Alignment Healthcare, Inc.			$	(26,413)					$	(35,047)					$	(96,944)					$	(100,808)
Denominator:
Total weighted-average common shares outstanding - basic and diluted			191,610,696						188,657,282						190,882,849						188,241,025
Less: Restricted shares of common stock			(249,413)						(1,328,964)						(459,835)						(2,747,680)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted			191,361,283						187,328,318						190,423,014						185,493,345
Net loss per share:
Net loss per share - basic and diluted			$	(0.14)					$	(0.19)					$	(0.51)					$	(0.54)

Basic net loss per share is the same as diluted net loss per share for 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, 2024 and 2023:

			September 30,
			2024						2023
Stock options			8,846,955						10,272,029
Restricted stock units			21,712,437						16,141,534
Total			30,559,392						26,413,563

Recent Accounting Pronouncements Issued

In November 2023, the FASB issued a new accounting standard ("ASU 2023-07") around segment disclosures. The new standard requires a public entity to disclose significant segment expenses and other segment items on an annual and interim basis and provide, in interim periods, all disclosures about a reportable segment’s profit or loss and assets that are currently required annually. Additionally, it requires a public entity to disclose the title and position of the Chief Operating Decision Maker. The ASU does not change how a public entity identifies its operating segments, aggregates them, or applies the quantitative thresholds to determine its reportable segments. The new standard is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. A public entity should apply the amendments in this ASU retrospectively to all prior periods presented in the financial statements. We expect this ASU to only impact our disclosures with no impacts to our results of operations, cash flows and financial condition.

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The following tables present the carrying value and fair value of these financial instruments as of September 30, 2024 and December 31, 2023:

			September 30, 2024
									Fair Value
			Carrying Value						Level 1						Level 2						Level 3
U.S. Treasury bills			$	74,980					$	75,034					$	—					$	—
Certificate of deposits			2,302						—						2,302						—
Total			$	77,282					$	75,034					$	2,302					$	—

			December 31, 2023
									Fair Value
			Carrying Value						Level 1						Level 2						Level 3
U.S. Treasury bills			$	117,337					$	117,310					$	—					$	—
Certificate of deposits			1,755						—						1,755						—
Total			$	119,092					$	117,310					$	1,755					$	—

The carrying value of long-term debt represents the outstanding balance, net of unamortized debt issuance costs. As of September 30, 2024 and December 31, 2023, 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. We recorded an impairment charge related to intangible assets as of September 30, 2024. See note 6, Goodwill and Intangible Assets. There was no such impairment as of December 31, 2023.

U.S. Treasury Securities Investments

As of September 30, 2024 and December 31, 2023, the Company had $40,676 and $115,914, respectively, 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 $54.

As of September 30, 2024 and December 31, 2023, the Company had $33,288 and $22,232, respectively, of investments in U.S. Treasury bill money market funds 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.

Restricted Investments

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Accounts receivable consisted of the following as of September 30, 2024 and December 31, 2023:

			September 30, 2024						December 31, 2023
Government receivables			$	25,161					$	35,529
Pharmacy rebate receivables			104,917						75,894
Other receivables			8,897						8,326
Total accounts receivable			138,975						119,749
Allowance for credit losses			(123)						—
Accounts receivable, net			$	138,852					$	119,749

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 a credit loss related to accounts receivable of $28 and $40 during the three months ended September 30, 2024 and 2023, respectively, and $123 and $91 during the nine months ended September 30, 2024 and 2023. The amounts were recorded in selling general, and administrative expenses in the condensed consolidated statements of operations.

Property and equipment consisted of the following as of September 30, 2024 and December 31, 2023:

			September 30, 2024						December 31, 2023
Computers and equipment			$	11,942					$	11,447
Office equipment and furniture			4,341						4,396
Software			172,178						148,864
Leasehold improvements			6,347						6,347
Construction in progress			12,640						4,532
Subtotal			207,448						175,586
Less accumulated depreciation			(142,756)						(123,685)
Property and equipment-net			$	64,692					$	51,901

Depreciation expense for the three months ended September 30, 2024 and 2023 was $7,036 and $5,534, respectively, of which $46 and $64, respectively, were included in medical expenses. Depreciation expense for the nine months ended September 30, 2024 and 2023 was $19,552 and $15,609, respectively, of which $144 and $194, respectively, were included in medical expenses.

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Intangible assets consisted of the following as of September 30, 2024 and December 31, 2023:

			September 30, 2024
			Gross Carrying Value						Accumulated Amortization						Net Carrying Value						Weighted Average Life
Goodwill			$	34,826					$	—					$	34,826					—
License (indefinite lived)			4,550						—						4,550						—
Plan member relationships			2,700						(2,700)						—						9 years
Other			633						(633)						—						2 - 10 years
Total			$	42,709					$	(3,333)					$	39,376

			December 31, 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						(765)						285						2 - 10 years
Total			$	43,543					$	(3,465)					$	40,078

Amortization expense relating to intangible assets for the three months ended September 30, 2024 and 2023, was $650 and $27, respectively. Amortization expense relating to intangible assets for the nine months ended September 30, 2024 and 2023, was $702 and $198, respectively. Included within the amortization balance for the three and nine months ended September 30, 2024 was $645 in impairment charges related to intangible assets that were written off during the quarter.

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

The following table is a detail of medical expenses payable as of September 30, 2024 and December 31, 2023:

			September 30, 2024						December 31, 2023
Claims incurred but not paid			$	158,174					$	95,664
Capitation and risk-sharing payable			42,239						50,894
Other			96,712						58,841
Medical expenses payable			$	297,125					$	205,399

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.

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The following table presents components of the change in medical expenses payable as of September 30, 2024 and 2023:

			September 30, 2024						September 30, 2023
Claims incurred but not paid - beginning balance			$	95,664					$	88,813
Incurred related to:
Current year			619,772						360,372
Prior years			(7,031)						(10,067)
Total incurred, net of reinsurance			612,741						350,305
Payments related to:
Current year			470,460						266,218
Prior years			79,771						71,000
Total payments, net of reinsurance			550,231						337,218
Claims incurred but not paid - ending balance			158,174						101,900
Capitation payable, risk-sharing payable, and other			138,951						101,535
Total medical expenses payable			$	297,125					$	203,435

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, 2024 and December 31, 2023:

			September 30, 2024						December 31, 2023
Long-term debt			$	215,000					$	165,000
Less unamortized debt issuance costs			(3,001)						(3,187)
Long-term debt-net of amortization			211,999						161,813
Less current maturities of long-term debt			(1,613)						—
Long-term debt - net of current portion			$	210,386					$	161,813

Oxford Term Loan

On September 2, 2022 (the "Effective Date"), Alignment Healthcare USA, LLC 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 had the option to borrow up to an additional $85,000 of Term Loans (such additional Term Loans, the “Delayed Draw Term Loans”). On June 14, 2024, we borrowed $50,000 in aggregate principal amount of the Delayed Draw Term Loans prior to the expiration date for such amount of the Delayed Draw Term Loans of June 30, 2024. As of September 30, 2024 we have the option to borrow an additional $35,000 in undrawn Delayed Draw Term Loans, which expires on September 1, 2025.

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%. Beginning January 1, 2025, principal payments of $538, 0.25% of the gross principal borrowed, are due on a quarterly basis. All unpaid principal and accrued and unpaid interest with respect to each Term Loan is due and payable in

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full on September 1, 2027. The interest rate applied during the nine months ended September 30, 2024 ranged from 11.70% to 11.85%.

The initial 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. We also incurred an origination fee of $500 related to the $50,000 draw down of the Delayed Draw Term Loans. 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 initial 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 jointly and severally guaranteed by Alignment Healthcare, Inc. and certain of our wholly owned subsidiaries and collateralized by all unrestricted assets.

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 $23,000 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, 2024 and December 31, 2023, we were in compliance with the Oxford financial covenants.

Future maturities under the term loan for each of the next five years ending December 31, are as follows:

			Amount
Remainder of 2024			$	—
2025			2,150
2026			2,150
2027			210,700
2028			—
			$	215,000

For the three and nine months ended September 30, 2024, we recorded income tax (benefit) expense of $(8) and $14, respectively. For the three and nine months ended September 30, 2023, we recorded income tax expense of $0 and $2, respectively. The change in tax for the three and nine months ended September 30, 2024 when compared to the three and nine months ended September 30, 2024 is primarily attributable to a change in state taxes. 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, 2024 and December 31, 2023. 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, 2024 and 2023. 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

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ended December 31, 2023 federal and state NOL carryforwards were $504,097 and $498,933, respectively. $312,446 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. On June 27, 2024, California Senate Bill 167 (“SB 167”) was enacted into law, suspending California NOL utilization for taxpayers with more than $1 million of taxable income, effective for tax years 2024, 2025, and 2026. SB 167 includes an extended carryover period for the suspended NOLs with an additional year carryforward for each year of suspension. The Company will continue to monitor this legislation and its impact on our deferred tax assets.

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.

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, 2024:

			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, 2023			9,135,879						$	16.95					7.29						$	79
Options granted			—						—
Options exercised			—						—
Options forfeited / expired			(112,536)						15.41
Balances as of March 31, 2024			9,023,343						$	16.97					7.04						—
Options granted			—						—
Options exercised			—						—
Options forfeited / expired			(73,754)						16.62
Balances as of June 30, 2024			8,949,589						$	16.97					6.79						27
Options granted			—						—
Options exercised			—						—
Options forfeited / expired			(102,634)						17.99
Balances as of September 30, 2024			8,846,955						$	16.96					6.54						$	2,862
Vested and Exercisable as of September 30, 2024			6,164,008						$	17.27					6.50						$	1,427

Aggregate intrinsic value represents the difference between the exercise price of the option and the closing price of our common stock. For the three and nine months ended September 30, 2024 and 2023, no options were exercised. No options were granted during the three and nine months ended September 30, 2024.

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Restricted Stock Awards

Our outstanding Restricted Stock Awards ("RSA") 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, 2024:

			Restricted Shares						Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023			683,953						$	5.86
Vested			(140,856)						13.22
Forfeited			(2,799)						5.05
Unvested and outstanding as of March 31, 2024			540,298						$	3.94
Vested			(3,056)						2.49
Forfeited			—						—
Unvested and outstanding as of June 30, 2024			537,242						$	3.95
Vested			(479,847)						2.49
Forfeited			—						—
Unvested and outstanding as of September 30, 2024			57,395						$	16.16

Restricted Stock Units

Our outstanding Restricted Stock Units ("RSU") generally vest 25% annually over four years.

The following is a summary of RSU transactions as of and for the three and nine months ended September 30, 2024:

			Restricted Stock Units						Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023			10,541,625						$	11.25
Granted			6,517,337						5.05
Vested(1)			(2,385,493)						8.25
Cancelled/forfeited			(282,972)						9.36
Unvested and outstanding as of March 31, 2024			14,390,497						$	8.97
Granted			103,292						5.62
Vested			(80,178)						6.07
Cancelled/forfeited			(395,338)						8.40
Unvested and outstanding as of June 30, 2024			14,018,273						$	8.98
Granted			255,391						8.26
Vested			(359,039)						9.77
Cancelled/forfeited			(293,726)						7.86
Unvested and outstanding as of September 30, 2024			13,620,899						$	8.97

(1) Includes 107,948 shares that vested, but the issuance and delivery of the shares was deferred.

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

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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.

On March 13, 2024, the Compensation Committee of the Board of Directors of the Company approved additional grants of PSUs under the Company's 2021 Equity Incentive Plan. Each grantee is eligible to vest in a number of PSUs ranging from 0% to 200% 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, 2026. The achievement of PSUs relative to the approved target is based on the following performance metrics and relative weighting: Revenue 50% and Adjusted EBITDA 50%. 100% 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, 2027, subject to continued service to the Company through such date.

The following is a summary of PSU transactions for the three and nine months ended September 30, 2024:

			Performance-based restricted stock units						Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2023			7,233,205						$	5.74
Granted			1,160,000						5.00
Vested			—						—
Cancelled/forfeited			(16,667)						5.74
Unvested and outstanding as of March 31, 2024			8,376,538						$	5.64
Granted			—						—
Vested			—						—
Cancelled/forfeited			(198,333)						5.67
Unvested and outstanding as of June 30, 2024			8,178,205						$	5.64
Granted			—						—
Vested			—						—
Cancelled/forfeited			(86,667)						5.74
Unvested and outstanding as of September 30, 2024			8,091,538						$	5.64

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)			2024						2023						2024						2023
Selling, general and administrative expenses			$	15,769					$	11,836					$	51,512					$	45,159
Medical expenses			1,489						1,733						3,384						6,024
Total equity-based compensation expense			$	17,258					$	13,569					$	54,896					$	51,183

As of September 30, 2024, there was $79,251 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 1.62 years.

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.

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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, 2024.

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, 2024.

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, 2024.

Restricted Assets

Pursuant to the regulations governing our subsidiaries, we maintain certain deposits required by the government authorities in the form of cash, certificate of deposit 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.

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 $913. The settlement of this matter is subject to approval by the court which is expected in the fourth quarter of 2024. As a result of the tentative settlement, the Company has accrued for a potential liability of $913 as of September 30, 2024 and December 31, 2023 for this matter,

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which was recorded within accounts payable and accrued expenses on the consolidated balance sheets and selling, general and administrative expenses on the consolidated statements of operations.

On July 7, 2023, a stockholder of Alignment filed a purported class action lawsuit (Maglione v. Alignment Healthcare, Inc., et al, Delaware Chancery Court). The plaintiff alleged that certain provisions of Alignment’s stockholder agreement with General Atlantic (“GA”) and Warburg Pincus violate Delaware law. On April 30, 2024, the Company agreed to amend the stockholder agreement to eliminate the provisions challenged by the Maglione plaintiff. On May 24, 2024, the parties filed a stipulation and proposed order voluntarily dismissing the action as moot, which the court granted. Pursuant to the order, the court retained jurisdiction regarding attorneys’ fees.

The Company has entered into discussions with plaintiffs’ counsel to negotiate with respect to attorney’s fees. Plaintiff’s counsel made a settlement demand and the Company presented a counteroffer that was rejected by plaintiff’s counsel. Negotiations remain ongoing. The Company expects losses related to this case to be immaterial.

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, 2024 and December 31, 2023.

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During the fiscal quarter ended September 30, 2024, our executive officers and directors adopted the following trading arrangements that are intended to satisfy the affirmative defense of Rule 10b5-1(c):

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Name & Title			Date of Adoption			Duration of Trading Arrangement			Maximum Number of Securities to be Sold(1)
Hyong (Ken) Kim, M.D. Chief Medical Officer			09/05/2024			12/5/2024 - 8/8/2025			145,034

(1)Securities reported in this column include securities subject to limit orders and such orders may not fill if limit order conditions are not met.

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v3.24.3

Cover - shares	9 Months Ended
	Sep. 30, 2024	Oct. 24, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	001-40295
Entity Registrant Name	ALIGNMENT HEALTHCARE, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	46-5596242
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
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 Common Stock, Shares Outstanding		191,696,093
Amendment Flag	false
Document Fiscal Period Focus	Q3
Current Fiscal Year End Date	--12-31
Entity Central Index Key	0001832466
Document Fiscal Year Focus	2024

v3.24.3

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current Assets:
Cash and cash equivalents	$ 340,300	$ 202,904
Accounts receivable (less allowance for credit losses of $123 at September 30, 2024 and $0 at December 31, 2023)	138,852	119,749
Investments - current	40,676	115,914
Prepaid expenses and other current assets	53,779	44,970
Total current assets	573,607	483,537
Property and equipment, net	64,692	51,901
Right of use asset, net	8,124	9,959
Goodwill, Net	34,826	34,826
Intangible Assets, net	4,550	5,252
Other assets	6,488	6,405
Total assets	692,287	591,880
Current Liabilities:
Medical expenses payable	297,125	205,399
Accounts payable and accrued expenses	25,394	23,511
Accrued compensation	33,951	34,112
Current maturities of long-term debt	1,613	0
Total current liabilities	358,083	263,022
Long-term debt, net of current maturities and debt issuance costs	210,386	161,813
Long-term portion of lease liabilities	8,191	8,974
Total liabilities	576,660	433,809
Commitments and Contingencies (Note 12)
Stockholders' Equity:
Preferred stock, $.001 par value; 100,000,000 shares authorized as of September 30, 2024 and December 31, 2023, respectively; no shares issued and outstanding as of September 30, 2024 and December 31, 2023	0	0
Common stock, $.001 par value; 1,000,000,000 shares authorized as of September 30, 2024 and December 31, 2023; 191,595,786 and 188,951,643 shares issued and outstanding as of September 30, 2024 and December 31, 2023, respectively	191	189
Additional paid-in capital	1,091,561	1,037,015
Accumulated deficit	(977,202)	(880,258)
Total Alignment Healthcare, Inc. stockholders' equity	114,550	156,946
Noncontrolling interest	1,077	1,125
Total stockholders' equity	115,627	158,071
Total liabilities and stockholders' equity	$ 692,287	$ 591,880

v3.24.3

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for credit losses	$ 123	$ 0
Preferred stock par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	100,000,000	100,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	1,000,000,000	1,000,000,000
Common stock, shares issued (in shares)		188,951,643
Common stock, shares outstanding (in shares)		188,951,643

v3.24.3

Condensed Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues:
Earned premiums	$ 684,496	$ 450,235	$ 1,980,146	$ 1,341,924
Other	7,937	6,474	22,174	16,319
Total revenues	692,433	456,709	2,002,320	1,358,243
Expenses:
Medical expenses	613,444	397,879	1,791,974	1,204,838
Selling, general, and administrative expenses	90,871	83,089	269,246	223,696
Depreciation and amortization	7,640	5,497	20,110	15,613
Total expenses	711,955	486,465	2,081,330	1,444,147
Loss from operations	(19,522)	(29,756)	(79,010)	(85,904)
Other expenses:
Interest expense	6,937	5,466	18,055	15,747
Other income, net	(22)	(145)	(72)	(711)
Total other expenses	6,915	5,321	17,983	15,036
Loss before income taxes	(26,437)	(35,077)	(96,993)	(100,940)
Provision (benefit) for income taxes	(8)	0	14	2
Net loss	(26,429)	(35,077)	(97,007)	(100,942)
Less: Net loss attributable to noncontrolling interest	16	30	63	134
Net loss attributable to Alignment Healthcare, Inc.	$ (26,413)	$ (35,047)	$ (96,944)	$ (100,808)
Total weighted-average common shares outstanding - basic (in shares)	191,361,283	187,328,318	190,423,014	185,493,345
Total weighted-average common shares outstanding - diluted (in shares)	191,361,283	187,328,318	190,423,014	185,493,345
Net loss per share - basic (in dollars per share)	$ (0.14)	$ (0.19)	$ (0.51)	$ (0.54)
Net loss per share - diluted (in dollars per share)	$ (0.14)	$ (0.19)	$ (0.51)	$ (0.54)

v3.24.3

Condensed Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Deficit	Noncontrolling Interest
Beginning Balance (in shares) at Dec. 31, 2022		187,280,015
Beginning Balance at Dec. 31, 2022	$ 239,302	$ 187	$ 970,180	$ (732,241)	$ 1,176
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(100,942)			(100,808)	(134)
Issuance of common stock upon vesting of restricted stock units (in shares)		1,667,102
Issuance of common stock upon vesting of restricted stock units	2	$ 2
Forfeitures (in shares)		(35,597)
Equity-based compensation	51,183		51,183
Repurchase of noncontrolling interest attributable to subsidiary	60				60
Ending Balance (in shares) at Sep. 30, 2023		188,911,520
Ending Balance at Sep. 30, 2023	189,605	$ 189	1,021,363	(833,049)	1,102
Beginning Balance (in shares) at Jun. 30, 2023		188,512,765
Beginning Balance at Jun. 30, 2023	211,112	$ 188	1,007,794	(798,002)	1,132
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(35,077)			(35,047)	(30)
Issuance of common stock upon vesting of restricted stock units (in shares)		419,130
Issuance of common stock upon vesting of restricted stock units	1	$ 1
Forfeitures (in shares)		(20,375)
Equity-based compensation	13,569		13,569
Ending Balance (in shares) at Sep. 30, 2023		188,911,520
Ending Balance at Sep. 30, 2023	$ 189,605	$ 189	1,021,363	(833,049)	1,102
Beginning Balance (in shares) at Dec. 31, 2023	188,951,643	188,951,643
Beginning Balance at Dec. 31, 2023	$ 158,071	$ 189	1,037,015	(880,258)	1,125
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(97,007)			(96,944)	(63)
Issuance of common stock upon vesting of restricted stock units (in shares)		2,716,762
Issuance of common stock upon vesting of restricted stock units	2	$ 2
Forfeitures (in shares)		(2,799)
Shares withheld related to net restricted stock settlement (in shares)		(69,820)
Shares withheld related to net restricted stock settlement	(350)		(350)
Equity-based compensation	54,896		54,896
Noncontrolling interest attributable to subsidiary	15				15
Ending Balance (in shares) at Sep. 30, 2024		191,595,786
Ending Balance at Sep. 30, 2024	115,627	$ 191	1,091,561	(977,202)	1,077
Beginning Balance (in shares) at Jun. 30, 2024		191,236,747
Beginning Balance at Jun. 30, 2024	124,798	$ 191	1,074,303	(950,789)	1,093
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(26,429)			(26,413)	(16)
Issuance of common stock upon vesting of restricted stock units (in shares)		359,039
Equity-based compensation	17,258		17,258
Ending Balance (in shares) at Sep. 30, 2024		191,595,786
Ending Balance at Sep. 30, 2024	$ 115,627	$ 191	$ 1,091,561	$ (977,202)	$ 1,077

v3.24.3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Operating Activities:
Net loss	$ (97,007)	$ (100,942)
Adjustments to reconcile net loss to net cash provided by operating activities:
Provision for credit loss	123	91
Loss (gain) on right of use assets	135	(289)
Gain on sale of property and equipment	(8)	0
Depreciation and amortization	20,254	15,807
Amortization-investment discount	(2,084)	(3,349)
Amortization-debt issuance costs	978	1,037
Equity-based compensation	54,896	51,183
Non-cash lease expense	1,360	1,653
Changes in operating assets and liabilities:
Accounts receivable	(19,226)	(12,724)
Prepaid expenses and other current assets	(8,809)	(3,771)
Other assets	77	(119)
Medical expenses payable	91,726	33,299
Accounts payable and accrued expenses	2,835	(4,613)
Deferred premium revenue	(116)	146,034
Accrued compensation	(161)	7,604
Lease liabilities	(1,492)	(2,622)
Net cash provided by operating activities	43,481	128,279
Investing Activities:
Purchase of investments	(75,524)	(281,582)
Sale of property and equipment	14	0
Maturities of investments	152,755	160,735
Acquisition of property and equipment	(32,134)	(25,398)
Net cash provided by (used in) investing activities	45,111	(146,245)
Financing Activities:
Proceeds from long-term debt	50,000	0
Debt issuance costs	(512)	0
Payment of employment taxes related to release of restricted stock	(350)	0
Contributions from noncontrolling interest holders	15	60
Net cash provided by financing activities	49,153	60
Net increase (decrease) in cash	137,745	(17,906)
Cash, cash equivalents and restricted cash at beginning of period	204,954	411,299
Cash, cash equivalents and restricted cash at end of period	342,699	393,393
Supplemental disclosure of cash flow information:
Cash paid for interest	15,602	13,943
Supplemental non-cash investing and financing activities:
Acquisition of property in accounts payable	112	117
Reconciliation of cash, cash equivalents and restricted cash as shown in the statement of cash flows:
Cash and cash equivalents	340,300	391,643
Restricted cash in other assets	2,399	1,750
Total	$ 342,699	$ 393,393

v3.24.3

Organization	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization	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.

v3.24.3

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies 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 balance sheet as of December 31, 2023, included herein, was derived from audited financial statements, but does not include all disclosures required by GAAP. In accordance with the rules and regulations of the U.S. Securities and Exchange Commission ("SEC"), the Company has omitted certain footnote disclosures that would substantially duplicate the disclosures contained in its annual audited consolidated financial statements. Therefore, these condensed consolidated financial statements should be read in conjunction with the Company's Annual Report on Form 10-K for the year-ended December 31, 2023 as filed with the SEC. Furthermore, 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, 2024 and December 31, 2023. 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, 2024 and 2023 were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Premium $ 683,270  $ 417,867  $ 1,976,524  $ 1,242,311  Capitation 1,226  32,368  3,622  99,613  Total $ 684,496  $ 450,235  $ 1,980,146  $ 1,341,924  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. In 2023, capitation revenue consisted primarily of revenue 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. We also participate in the CMS ACO REACH program, formerly the Direct Contracting Model ("DCE"). CMS serves as the claim adjudicator for institutional and specialists care, and directly pays for such fee for service claims. 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. In 2024, we entered into a management services and risk management agreement with a third-party healthcare company. The third party will be responsible for arranging and controlling the health care services provided to the ACO members, and for providing certain management and support services with respect to ACO operations. The third party will also assume specified upside and downside financial risk relative to the ACO’s performance. As a result of this arrangement, revenue is recorded on a net basis within other revenue on the condensed consolidated statement of operations for the three and nine months ended September 30, 2024. Revenue recognized by the ACO for the three and nine months ended September 30, 2024 was $212 and $453, respectively. Prior to 2024, the ACO acted 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 were determined from an annual benchmark established by CMS. These payments, which were adjusted for variable considerations, represented revenue for providing health care services, including primary care as well as institutional and specialist care. The ACO recognized capitation revenue for providing these services in the period in which the performance obligations were 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. 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, 2024 was $6,649 and $17,694, respectively. Interest income for the three and nine months ended September 30, 2023 was $5,523 and $13,967, 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, 2024 and December 31, 2023. 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 sheets 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. 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 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. In 2023, we also recorded claims expenses related to our institutional and specialist care related to our ACO program with CMS as we acted as the principal in the transaction. As discussed above, beginning in 2024, claims expense related to the ACO program is netted against ACO revenue as we act as the agent in these transactions. 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 sheets. 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. There was no material impact on our consolidated financial statements at September 30, 2024, and we do not anticipate a material impact to operations for the remainder of fiscal year 2024. We are in the process of evaluating the impact the IRA will have on our business for fiscal years beyond 2024. 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 sheets. 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, 2024 and December 31, 2023, we recorded an allowance for credit losses 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 sheets. Concentrations of Credit Risk Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash deposits and current 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, 2024 and December 31, 2023, there was $379,464 and $316,977, 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 on the date of grant. 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. 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, 2024 and 2023:   Three Months Ended September 30, Nine Months Ended September 30,   2024 2023 2024 2023 Numerator: Net loss $ (26,429) $ (35,077) $ (97,007) $ (100,942) Less: Net loss attributable to noncontrolling interests 16  30  63  134  Net loss attributable to Alignment Healthcare, Inc. $ (26,413) $ (35,047) $ (96,944) $ (100,808) Denominator: Total weighted-average common shares outstanding - basic and diluted 191,610,696 188,657,282 190,882,849 188,241,025 Less: Restricted shares of common stock (249,413) (1,328,964) (459,835) (2,747,680) Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted 191,361,283 187,328,318 190,423,014 185,493,345 Net loss per share: Net loss per share - basic and diluted $ (0.14) $ (0.19) $ (0.51) $ (0.54) Basic net loss per share is the same as diluted net loss per share for 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, 2024 and 2023:   September 30,   2024 2023 Stock options 8,846,955 10,272,029 Restricted stock units 21,712,437 16,141,534 Total 30,559,392 26,413,563 Recent Accounting Pronouncements Issued In November 2023, the FASB issued a new accounting standard ("ASU 2023-07") around segment disclosures. The new standard requires a public entity to disclose significant segment expenses and other segment items on an annual and interim basis and provide, in interim periods, all disclosures about a reportable segment’s profit or loss and assets that are currently required annually. Additionally, it requires a public entity to disclose the title and position of the Chief Operating Decision Maker. The ASU does not change how a public entity identifies its operating segments, aggregates them, or applies the quantitative thresholds to determine its reportable segments. The new standard is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. A public entity should apply the amendments in this ASU retrospectively to all prior periods presented in the financial statements. We expect this ASU to only impact our disclosures with no impacts to our results of operations, cash flows and financial condition.

v3.24.3

Fair Value	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Fair Value	Fair Value The following tables present the carrying value and fair value of these financial instruments as of September 30, 2024 and December 31, 2023: September 30, 2024 Fair Value Carrying Value Level 1 Level 2 Level 3 U.S. Treasury bills $ 74,980  $ 75,034  $ —  $ —  Certificate of deposits 2,302  —  2,302  —  Total $ 77,282  $ 75,034  $ 2,302  $ —  December 31, 2023 Fair Value Carrying Value Level 1 Level 2 Level 3 U.S. Treasury bills $ 117,337  $ 117,310  $ —  $ —  Certificate of deposits 1,755  —  1,755  —  Total $ 119,092  $ 117,310  $ 1,755  $ —  The carrying value of long-term debt represents the outstanding balance, net of unamortized debt issuance costs. As of September 30, 2024 and December 31, 2023, 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. We recorded an impairment charge related to intangible assets as of September 30, 2024. See note 6, Goodwill and Intangible Assets. There was no such impairment as of December 31, 2023. U.S. Treasury Securities Investments As of September 30, 2024 and December 31, 2023, the Company had $40,676 and $115,914, respectively, 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 $54. As of September 30, 2024 and December 31, 2023, the Company had $33,288 and $22,232, respectively, of investments in U.S. Treasury bill money market funds 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. 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, 2024 and December 31, 2023, the Company had $1,016 and $1,423 of restricted investments in U.S. Treasury bills and $2,302 and $1,755 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, 2024 and December 31, 2023, 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.

v3.24.3

Accounts Receivable	9 Months Ended
	Sep. 30, 2024
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Accounts Receivable	Accounts Receivable Accounts receivable consisted of the following as of September 30, 2024 and December 31, 2023:   September 30, 2024 December 31, 2023 Government receivables $ 25,161  $ 35,529  Pharmacy rebate receivables 104,917  75,894  Other receivables 8,897  8,326  Total accounts receivable 138,975  119,749  Allowance for credit losses (123) —  Accounts receivable, net $ 138,852  $ 119,749  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 a credit loss related to accounts receivable of $28 and $40 during the three months ended September 30, 2024 and 2023, respectively, and $123 and $91 during the nine months ended September 30, 2024 and 2023. The amounts were recorded in selling general, and administrative expenses in the condensed consolidated statements of operations.

v3.24.3

Property and Equipment	9 Months Ended
	Sep. 30, 2024
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consisted of the following as of September 30, 2024 and December 31, 2023: September 30, 2024 December 31, 2023 Computers and equipment $ 11,942  $ 11,447  Office equipment and furniture 4,341  4,396  Software 172,178  148,864  Leasehold improvements 6,347  6,347  Construction in progress 12,640  4,532  Subtotal 207,448  175,586  Less accumulated depreciation (142,756) (123,685) Property and equipment-net $ 64,692  $ 51,901  Depreciation expense for the three months ended September 30, 2024 and 2023 was $7,036 and $5,534, respectively, of which $46 and $64, respectively, were included in medical expenses. Depreciation expense for the nine months ended September 30, 2024 and 2023 was $19,552 and $15,609, respectively, of which $144 and $194, respectively, were included in medical expenses.

v3.24.3

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets Intangible assets consisted of the following as of September 30, 2024 and December 31, 2023: September 30, 2024 Gross Carrying Value Accumulated Amortization Net Carrying Value Weighted Average Life Goodwill $ 34,826  $ —  $ 34,826  — License (indefinite lived) 4,550  —  4,550  — Plan member relationships 2,700  (2,700) —  9 years Other 633  (633) —  2 - 10 years Total $ 42,709  $ (3,333) $ 39,376    December 31, 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  (765) 285  2 - 10 years Total $ 43,543  $ (3,465) $ 40,078    Amortization expense relating to intangible assets for the three months ended September 30, 2024 and 2023, was $650 and $27, respectively. Amortization expense relating to intangible assets for the nine months ended September 30, 2024 and 2023, was $702 and $198, respectively. Included within the amortization balance for the three and nine months ended September 30, 2024 was $645 in impairment charges related to intangible assets that were written off during the quarter. There were no impairment charges related to goodwill and intangible assets for the three and nine months ended September 30, 2023.

v3.24.3

Medical Expenses Payable	9 Months Ended
	Sep. 30, 2024
Insurance [Abstract]
Medical Expenses Payable	Medical Expenses Payable The following table is a detail of medical expenses payable as of September 30, 2024 and December 31, 2023:   September 30, 2024 December 31, 2023 Claims incurred but not paid $ 158,174  $ 95,664  Capitation and risk-sharing payable 42,239  50,894  Other 96,712  58,841  Medical expenses payable $ 297,125  $ 205,399  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, 2024 and 2023: September 30, 2024 September 30, 2023 Claims incurred but not paid - beginning balance $ 95,664  $ 88,813  Incurred related to: Current year 619,772  360,372  Prior years (7,031) (10,067) Total incurred, net of reinsurance 612,741  350,305  Payments related to: Current year 470,460  266,218  Prior years 79,771  71,000  Total payments, net of reinsurance 550,231  337,218  Claims incurred but not paid - ending balance 158,174  101,900  Capitation payable, risk-sharing payable, and other 138,951  101,535  Total medical expenses payable $ 297,125  $ 203,435  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 $548 and $3,879 for the three and nine months ended September 30, 2024, respectively. The favorable prior year development was primarily due to better-than-expected claims recoveries and actual claims expense being less than expected.

v3.24.3

Long-Term Debt	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt 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, 2024 and December 31, 2023: September 30, 2024 December 31, 2023 Long-term debt $ 215,000  $ 165,000  Less unamortized debt issuance costs (3,001) (3,187) Long-term debt-net of amortization 211,999  161,813  Less current maturities of long-term debt (1,613) —  Long-term debt - net of current portion $ 210,386  $ 161,813  Oxford Term Loan On September 2, 2022 (the "Effective Date"), Alignment Healthcare USA, LLC 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 had the option to borrow up to an additional $85,000 of Term Loans (such additional Term Loans, the “Delayed Draw Term Loans”). On June 14, 2024, we borrowed $50,000 in aggregate principal amount of the Delayed Draw Term Loans prior to the expiration date for such amount of the Delayed Draw Term Loans of June 30, 2024. As of September 30, 2024 we have the option to borrow an additional $35,000 in undrawn Delayed Draw Term Loans, which expires on September 1, 2025. 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%. Beginning January 1, 2025, principal payments of $538, 0.25% of the gross principal borrowed, are due on a quarterly basis. 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 nine months ended September 30, 2024 ranged from 11.70% to 11.85%. The initial 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. We also incurred an origination fee of $500 related to the $50,000 draw down of the Delayed Draw Term Loans. 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 initial 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 jointly and severally guaranteed by Alignment Healthcare, Inc. and certain of our wholly owned subsidiaries and collateralized by all unrestricted assets. 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 $23,000 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, 2024 and December 31, 2023, we were in compliance with the Oxford financial covenants. Future maturities under the term loan for each of the next five years ending December 31, are as follows: Amount Remainder of 2024 $ —  2025 2,150  2026 2,150  2027 210,700  2028 —  $ 215,000

v3.24.3

Income Taxes	9 Months Ended
	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes For the three and nine months ended September 30, 2024, we recorded income tax (benefit) expense of $(8) and $14, respectively. For the three and nine months ended September 30, 2023, we recorded income tax expense of $0 and $2, respectively. The change in tax for the three and nine months ended September 30, 2024 when compared to the three and nine months ended September 30, 2024 is primarily attributable to a change in state taxes. 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, 2024 and December 31, 2023. 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, 2024 and 2023. 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, 2023 federal and state NOL carryforwards were $504,097 and $498,933, respectively. $312,446 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. On June 27, 2024, California Senate Bill 167 (“SB 167”) was enacted into law, suspending California NOL utilization for taxpayers with more than $1 million of taxable income, effective for tax years 2024, 2025, and 2026. SB 167 includes an extended carryover period for the suspended NOLs with an additional year carryforward for each year of suspension. The Company will continue to monitor this legislation and its impact on our deferred tax assets. 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.

v3.24.3

Equity-Based Compensation	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]
Equity-Based Compensation	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, 2024:   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, 2023 9,135,879 $ 16.95  7.29 $ 79  Options granted — —    Options exercised — —    Options forfeited / expired (112,536) 15.41    Balances as of March 31, 2024 9,023,343 $ 16.97  7.04 —  Options granted — —    Options exercised — —    Options forfeited / expired (73,754) 16.62    Balances as of June 30, 2024 8,949,589 $ 16.97  6.79 27  Options granted — —  Options exercised — —    Options forfeited / expired (102,634) 17.99    Balances as of September 30, 2024 8,846,955 $ 16.96  6.54 $ 2,862  Vested and Exercisable as of September 30, 2024 6,164,008 $ 17.27  6.50 $ 1,427  Aggregate intrinsic value represents the difference between the exercise price of the option and the closing price of our common stock. For the three and nine months ended September 30, 2024 and 2023, no options were exercised. No options were granted during the three and nine months ended September 30, 2024. Restricted Stock Awards Our outstanding Restricted Stock Awards ("RSA") 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, 2024:   Restricted Shares Weighted-Average Grant Date Fair Value Unvested and outstanding as of December 31, 2023 683,953 $ 5.86  Vested (140,856) 13.22  Forfeited (2,799) 5.05  Unvested and outstanding as of March 31, 2024 540,298 $ 3.94  Vested (3,056) 2.49  Forfeited — —  Unvested and outstanding as of June 30, 2024 537,242 $ 3.95  Vested (479,847) 2.49  Forfeited — —  Unvested and outstanding as of September 30, 2024 57,395 $ 16.16  Restricted Stock Units Our outstanding Restricted Stock Units ("RSU") generally vest 25% annually over four years. The following is a summary of RSU transactions as of and for the three and nine months ended September 30, 2024:   Restricted Stock Units Weighted-Average Grant Date Fair Value Unvested and outstanding as of December 31, 2023 10,541,625 $ 11.25  Granted 6,517,337 5.05 Vested(1) (2,385,493) 8.25 Cancelled/forfeited (282,972) 9.36 Unvested and outstanding as of March 31, 2024 14,390,497 $ 8.97  Granted 103,292 5.62 Vested (80,178) 6.07 Cancelled/forfeited (395,338) 8.40 Unvested and outstanding as of June 30, 2024 14,018,273 $ 8.98  Granted 255,391 8.26 Vested (359,039) 9.77 Cancelled/forfeited (293,726) 7.86 Unvested and outstanding as of September 30, 2024 13,620,899 $ 8.97  (1) Includes 107,948 shares that vested, but the issuance and delivery of the shares was deferred. 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. On March 13, 2024, the Compensation Committee of the Board of Directors of the Company approved additional grants of PSUs under the Company's 2021 Equity Incentive Plan. Each grantee is eligible to vest in a number of PSUs ranging from 0% to 200% 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, 2026. The achievement of PSUs relative to the approved target is based on the following performance metrics and relative weighting: Revenue 50% and Adjusted EBITDA 50%. 100% 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, 2027, subject to continued service to the Company through such date. The following is a summary of PSU transactions for the three and nine months ended September 30, 2024:   Performance-based restricted stock units Weighted-Average Grant Date Fair Value Unvested and outstanding as of December 31, 2023 7,233,205 $ 5.74  Granted 1,160,000 5.00  Vested — —  Cancelled/forfeited (16,667) 5.74  Unvested and outstanding as of March 31, 2024 8,376,538 $ 5.64  Granted — —  Vested — —  Cancelled/forfeited (198,333) 5.67  Unvested and outstanding as of June 30, 2024 8,178,205 $ 5.64  Granted — —  Vested — —  Cancelled/forfeited (86,667) 5.74  Unvested and outstanding as of September 30, 2024 8,091,538 $ 5.64  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) 2024 2023 2024 2023 Selling, general and administrative expenses $ 15,769  $ 11,836  $ 51,512  $ 45,159  Medical expenses 1,489  1,733  3,384  6,024  Total equity-based compensation expense $ 17,258  $ 13,569  $ 54,896  $ 51,183  As of September 30, 2024, there was $79,251 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 1.62 years.

v3.24.3

Regulatory Requirements and Restricted Funds	9 Months Ended
	Sep. 30, 2024
Regulated Operations [Abstract]
Regulatory Requirements and Restricted Funds	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, 2024. 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, 2024. 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, 2024. Restricted Assets Pursuant to the regulations governing our subsidiaries, we maintain certain deposits required by the government authorities in the form of cash, certificate of deposit 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. See note 3, Fair Value, for further discussion.

v3.24.3

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	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 $913. The settlement of this matter is subject to approval by the court which is expected in the fourth quarter of 2024. As a result of the tentative settlement, the Company has accrued for a potential liability of $913 as of September 30, 2024 and December 31, 2023 for this matter, which was recorded within accounts payable and accrued expenses on the consolidated balance sheets and selling, general and administrative expenses on the consolidated statements of operations. On July 7, 2023, a stockholder of Alignment filed a purported class action lawsuit (Maglione v. Alignment Healthcare, Inc., et al, Delaware Chancery Court). The plaintiff alleged that certain provisions of Alignment’s stockholder agreement with General Atlantic (“GA”) and Warburg Pincus violate Delaware law. On April 30, 2024, the Company agreed to amend the stockholder agreement to eliminate the provisions challenged by the Maglione plaintiff. On May 24, 2024, the parties filed a stipulation and proposed order voluntarily dismissing the action as moot, which the court granted. Pursuant to the order, the court retained jurisdiction regarding attorneys’ fees. The Company has entered into discussions with plaintiffs’ counsel to negotiate with respect to attorney’s fees. Plaintiff’s counsel made a settlement demand and the Company presented a counteroffer that was rejected by plaintiff’s counsel. Negotiations remain ongoing. The Company expects losses related to this case to be immaterial. 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, 2024 and December 31, 2023.

v3.24.3

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net loss	$ (26,413)	$ (35,047)	$ (96,944)	$ (100,808)

v3.24.3

Insider Trading Arrangements	3 Months Ended	9 Months Ended
	Sep. 30, 2024 shares	Sep. 30, 2024 shares
Trading Arrangements, by Individual
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Hyong (Ken) Kim [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		During the fiscal quarter ended September 30, 2024, our executive officers and directors adopted the following trading arrangements that are intended to satisfy the affirmative defense of Rule 10b5-1(c): Name & Title Date of Adoption Duration of Trading Arrangement Maximum Number of Securities to be Sold(1) Hyong (Ken) Kim, M.D. Chief Medical Officer 09/05/2024 12/5/2024 - 8/8/2025 145,034 (1)Securities reported in this column include securities subject to limit orders and such orders may not fill if limit order conditions are not met.
Name	Hyong (Ken) Kim, M.D.
Title	Chief Medical Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	09/05/2024
Arrangement Duration	246 days
Aggregate Available	145,034	145,034

v3.24.3

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2024
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 balance sheet as of December 31, 2023, included herein, was derived from audited financial statements, but does not include all disclosures required by GAAP. In accordance with the rules and regulations of the U.S. Securities and Exchange Commission ("SEC"), the Company has omitted certain footnote disclosures that would substantially duplicate the disclosures contained in its annual audited consolidated financial statements. Therefore, these condensed consolidated financial statements should be read in conjunction with the Company's Annual Report on Form 10-K for the year-ended December 31, 2023 as filed with the SEC. Furthermore, 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, 2024 and December 31, 2023. Our long-term debt was reported at carrying value.
Revenue and Accounts Receivable	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. In 2023, capitation revenue consisted primarily of revenue 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. We also participate in the CMS ACO REACH program, formerly the Direct Contracting Model ("DCE"). CMS serves as the claim adjudicator for institutional and specialists care, and directly pays for such fee for service claims. 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. In 2024, we entered into a management services and risk management agreement with a third-party healthcare company. The third party will be responsible for arranging and controlling the health care services provided to the ACO members, and for providing certain management and support services with respect to ACO operations. The third party will also assume specified upside and downside financial risk relative to the ACO’s performance. As a result of this arrangement, revenue is recorded on a net basis within other revenue on the condensed consolidated statement of operations for the three and nine months ended September 30, 2024. Revenue recognized by the ACO for the three and nine months ended September 30, 2024 was $212 and $453, respectively. Prior to 2024, the ACO acted 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 were determined from an annual benchmark established by CMS. These payments, which were adjusted for variable considerations, represented revenue for providing health care services, including primary care as well as institutional and specialist care. The ACO recognized capitation revenue for providing these services in the period in which the performance obligations were 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. Interest income earned on our cash deposits and short-term investments is included within other revenue on the condensed consolidated statements of operations. 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, 2024 and December 31, 2023. 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 sheets 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 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.
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. In 2023, we also recorded claims expenses related to our institutional and specialist care related to our ACO program with CMS as we acted as the principal in the transaction. As discussed above, beginning in 2024, claims expense related to the ACO program is netted against ACO revenue as we act as the agent in these transactions. 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 sheets. 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. There was no material impact on our consolidated financial statements at September 30, 2024, and we do not anticipate a material impact to operations for the remainder of fiscal year 2024. We are in the process of evaluating the impact the IRA will have on our business for fiscal years beyond 2024. 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	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. In 2023, capitation revenue consisted primarily of revenue 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. We also participate in the CMS ACO REACH program, formerly the Direct Contracting Model ("DCE"). CMS serves as the claim adjudicator for institutional and specialists care, and directly pays for such fee for service claims. 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. In 2024, we entered into a management services and risk management agreement with a third-party healthcare company. The third party will be responsible for arranging and controlling the health care services provided to the ACO members, and for providing certain management and support services with respect to ACO operations. The third party will also assume specified upside and downside financial risk relative to the ACO’s performance. As a result of this arrangement, revenue is recorded on a net basis within other revenue on the condensed consolidated statement of operations for the three and nine months ended September 30, 2024. Revenue recognized by the ACO for the three and nine months ended September 30, 2024 was $212 and $453, respectively. Prior to 2024, the ACO acted 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 were determined from an annual benchmark established by CMS. These payments, which were adjusted for variable considerations, represented revenue for providing health care services, including primary care as well as institutional and specialist care. The ACO recognized capitation revenue for providing these services in the period in which the performance obligations were 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. Interest income earned on our cash deposits and short-term investments is included within other revenue on the condensed consolidated statements of operations. 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, 2024 and December 31, 2023. 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 sheets 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 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 sheets. 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, 2024 and December 31, 2023, we recorded an allowance for credit losses 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 sheets.
Concentrations of Credit Risk	Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash deposits and current and restricted investments with financial institutions. Accounts at each financial institution are insured by the Federal Deposit Insurance Corporation (“FDIC”) up to certain 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 on the date of grant. 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.
Net Loss per Share	Net loss per share is calculated based on net loss attributable to Alignment Healthcare, Inc.'s stockholders.
Recent Accounting Pronouncements Issued	In November 2023, the FASB issued a new accounting standard ("ASU 2023-07") around segment disclosures. The new standard requires a public entity to disclose significant segment expenses and other segment items on an annual and interim basis and provide, in interim periods, all disclosures about a reportable segment’s profit or loss and assets that are currently required annually. Additionally, it requires a public entity to disclose the title and position of the Chief Operating Decision Maker. The ASU does not change how a public entity identifies its operating segments, aggregates them, or applies the quantitative thresholds to determine its reportable segments. The new standard is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. A public entity should apply the amendments in this ASU retrospectively to all prior periods presented in the financial statements. We expect this ASU to only impact our disclosures with no impacts to our results of operations, cash flows and financial condition.

v3.24.3

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 and 2023 were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Premium $ 683,270  $ 417,867  $ 1,976,524  $ 1,242,311  Capitation 1,226  32,368  3,622  99,613  Total $ 684,496  $ 450,235  $ 1,980,146  $ 1,341,924
Schedule of Property and Equipment	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) Property and equipment consisted of the following as of September 30, 2024 and December 31, 2023: September 30, 2024 December 31, 2023 Computers and equipment $ 11,942  $ 11,447  Office equipment and furniture 4,341  4,396  Software 172,178  148,864  Leasehold improvements 6,347  6,347  Construction in progress 12,640  4,532  Subtotal 207,448  175,586  Less accumulated depreciation (142,756) (123,685) Property and equipment-net $ 64,692  $ 51,901
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, 2024 and 2023:   Three Months Ended September 30, Nine Months Ended September 30,   2024 2023 2024 2023 Numerator: Net loss $ (26,429) $ (35,077) $ (97,007) $ (100,942) Less: Net loss attributable to noncontrolling interests 16  30  63  134  Net loss attributable to Alignment Healthcare, Inc. $ (26,413) $ (35,047) $ (96,944) $ (100,808) Denominator: Total weighted-average common shares outstanding - basic and diluted 191,610,696 188,657,282 190,882,849 188,241,025 Less: Restricted shares of common stock (249,413) (1,328,964) (459,835) (2,747,680) Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted 191,361,283 187,328,318 190,423,014 185,493,345 Net loss per share: Net loss per share - basic and diluted $ (0.14) $ (0.19) $ (0.51) $ (0.54)
Schedule of Computation of Diluted Net Loss Per Share	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, 2024 and 2023:   September 30,   2024 2023 Stock options 8,846,955 10,272,029 Restricted stock units 21,712,437 16,141,534 Total 30,559,392 26,413,563

v3.24.3

Fair Value (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 and December 31, 2023: September 30, 2024 Fair Value Carrying Value Level 1 Level 2 Level 3 U.S. Treasury bills $ 74,980  $ 75,034  $ —  $ —  Certificate of deposits 2,302  —  2,302  —  Total $ 77,282  $ 75,034  $ 2,302  $ —  December 31, 2023 Fair Value Carrying Value Level 1 Level 2 Level 3 U.S. Treasury bills $ 117,337  $ 117,310  $ —  $ —  Certificate of deposits 1,755  —  1,755  —  Total $ 119,092  $ 117,310  $ 1,755  $ —

v3.24.3

Accounts Receivable (Tables)	9 Months Ended
	Sep. 30, 2024
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Schedule of Accounts Receivable	Accounts receivable consisted of the following as of September 30, 2024 and December 31, 2023:   September 30, 2024 December 31, 2023 Government receivables $ 25,161  $ 35,529  Pharmacy rebate receivables 104,917  75,894  Other receivables 8,897  8,326  Total accounts receivable 138,975  119,749  Allowance for credit losses (123) —  Accounts receivable, net $ 138,852  $ 119,749

v3.24.3

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2024
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	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) Property and equipment consisted of the following as of September 30, 2024 and December 31, 2023: September 30, 2024 December 31, 2023 Computers and equipment $ 11,942  $ 11,447  Office equipment and furniture 4,341  4,396  Software 172,178  148,864  Leasehold improvements 6,347  6,347  Construction in progress 12,640  4,532  Subtotal 207,448  175,586  Less accumulated depreciation (142,756) (123,685) Property and equipment-net $ 64,692  $ 51,901

v3.24.3

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	Intangible assets consisted of the following as of September 30, 2024 and December 31, 2023: September 30, 2024 Gross Carrying Value Accumulated Amortization Net Carrying Value Weighted Average Life Goodwill $ 34,826  $ —  $ 34,826  — License (indefinite lived) 4,550  —  4,550  — Plan member relationships 2,700  (2,700) —  9 years Other 633  (633) —  2 - 10 years Total $ 42,709  $ (3,333) $ 39,376    December 31, 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  (765) 285  2 - 10 years Total $ 43,543  $ (3,465) $ 40,078

v3.24.3

Medical Expenses Payable (Tables)	9 Months Ended
	Sep. 30, 2024
Insurance [Abstract]
Schedule of Medical Expenses Payable	The following table is a detail of medical expenses payable as of September 30, 2024 and December 31, 2023:   September 30, 2024 December 31, 2023 Claims incurred but not paid $ 158,174  $ 95,664  Capitation and risk-sharing payable 42,239  50,894  Other 96,712  58,841  Medical expenses payable $ 297,125  $ 205,399
Schedule of Components of Change in Medical Expenses Payable	The following table presents components of the change in medical expenses payable as of September 30, 2024 and 2023: September 30, 2024 September 30, 2023 Claims incurred but not paid - beginning balance $ 95,664  $ 88,813  Incurred related to: Current year 619,772  360,372  Prior years (7,031) (10,067) Total incurred, net of reinsurance 612,741  350,305  Payments related to: Current year 470,460  266,218  Prior years 79,771  71,000  Total payments, net of reinsurance 550,231  337,218  Claims incurred but not paid - ending balance 158,174  101,900  Capitation payable, risk-sharing payable, and other 138,951  101,535  Total medical expenses payable $ 297,125  $ 203,435

v3.24.3

Long-Term Debt (Tables)	9 Months Ended
	Sep. 30, 2024
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, 2024 and December 31, 2023: September 30, 2024 December 31, 2023 Long-term debt $ 215,000  $ 165,000  Less unamortized debt issuance costs (3,001) (3,187) Long-term debt-net of amortization 211,999  161,813  Less current maturities of long-term debt (1,613) —  Long-term debt - net of current portion $ 210,386  $ 161,813
Schedule of Future Maturities Under the Term Loan	Future maturities under the term loan for each of the next five years ending December 31, are as follows: Amount Remainder of 2024 $ —  2025 2,150  2026 2,150  2027 210,700  2028 —  $ 215,000

v3.24.3

Equity-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]
Schedule 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, 2024:   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, 2023 9,135,879 $ 16.95  7.29 $ 79  Options granted — —    Options exercised — —    Options forfeited / expired (112,536) 15.41    Balances as of March 31, 2024 9,023,343 $ 16.97  7.04 —  Options granted — —    Options exercised — —    Options forfeited / expired (73,754) 16.62    Balances as of June 30, 2024 8,949,589 $ 16.97  6.79 27  Options granted — —  Options exercised — —    Options forfeited / expired (102,634) 17.99    Balances as of September 30, 2024 8,846,955 $ 16.96  6.54 $ 2,862  Vested and Exercisable as of September 30, 2024 6,164,008 $ 17.27  6.50 $ 1,427
Schedule of Restricted Stock Transactions	The following is a summary of RSA transactions for the three and nine months ended September 30, 2024:   Restricted Shares Weighted-Average Grant Date Fair Value Unvested and outstanding as of December 31, 2023 683,953 $ 5.86  Vested (140,856) 13.22  Forfeited (2,799) 5.05  Unvested and outstanding as of March 31, 2024 540,298 $ 3.94  Vested (3,056) 2.49  Forfeited — —  Unvested and outstanding as of June 30, 2024 537,242 $ 3.95  Vested (479,847) 2.49  Forfeited — —  Unvested and outstanding as of September 30, 2024 57,395 $ 16.16  The following is a summary of RSU transactions as of and for the three and nine months ended September 30, 2024:   Restricted Stock Units Weighted-Average Grant Date Fair Value Unvested and outstanding as of December 31, 2023 10,541,625 $ 11.25  Granted 6,517,337 5.05 Vested(1) (2,385,493) 8.25 Cancelled/forfeited (282,972) 9.36 Unvested and outstanding as of March 31, 2024 14,390,497 $ 8.97  Granted 103,292 5.62 Vested (80,178) 6.07 Cancelled/forfeited (395,338) 8.40 Unvested and outstanding as of June 30, 2024 14,018,273 $ 8.98  Granted 255,391 8.26 Vested (359,039) 9.77 Cancelled/forfeited (293,726) 7.86 Unvested and outstanding as of September 30, 2024 13,620,899 $ 8.97  (1) Includes 107,948 shares that vested, but the issuance and delivery of the shares was deferred.
Schedule of PSUs Transactions	The following is a summary of PSU transactions for the three and nine months ended September 30, 2024:   Performance-based restricted stock units Weighted-Average Grant Date Fair Value Unvested and outstanding as of December 31, 2023 7,233,205 $ 5.74  Granted 1,160,000 5.00  Vested — —  Cancelled/forfeited (16,667) 5.74  Unvested and outstanding as of March 31, 2024 8,376,538 $ 5.64  Granted — —  Vested — —  Cancelled/forfeited (198,333) 5.67  Unvested and outstanding as of June 30, 2024 8,178,205 $ 5.64  Granted — —  Vested — —  Cancelled/forfeited (86,667) 5.74  Unvested and outstanding as of September 30, 2024 8,091,538 $ 5.64
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) 2024 2023 2024 2023 Selling, general and administrative expenses $ 15,769  $ 11,836  $ 51,512  $ 45,159  Medical expenses 1,489  1,733  3,384  6,024  Total equity-based compensation expense $ 17,258  $ 13,569  $ 54,896  $ 51,183

v3.24.3

Summary of Significant Accounting Policies - Additional Information (Details)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) segment Entity	Sep. 30, 2023 USD ($)	Dec. 31, 2023 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	$ 77,282,000		$ 77,282,000		$ 119,092,000
Revenues	692,433,000	$ 456,709,000	2,002,320,000	$ 1,358,243,000
Interest income earned	6,649,000	5,523,000	$ 17,694,000	13,967,000
Percentage of consumer discounts on brand name			75.00%
Federal deposit insurance corporation premium expense			$ 379,464,000		316,977,000
Award requisite service period			4 years
Net loss attributable to noncontrolling interest	16,000	30,000	$ 63,000	134,000
Minimum
Accounting Policies [Line Items]
Loss ratio			85.00%
Realizing Equity, Access, and Community Health (REACH) Model
Accounting Policies [Line Items]
Revenues	212,000	$ 30,476,000	$ 453,000	$ 92,703,000
Level 3
Accounting Policies [Line Items]
Assets, fair value disclosure	0		0		0
Liabilities, fair value disclosure	$ 0		$ 0		$ 0

v3.24.3

Summary of Significant Accounting Policies - Schedule of Earned Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Earned premiums	$ 684,496	$ 450,235	$ 1,980,146	$ 1,341,924
Premium
Disaggregation of Revenue [Line Items]
Earned premiums	683,270	417,867	1,976,524	1,242,311
Capitation
Disaggregation of Revenue [Line Items]
Earned premiums	$ 1,226	$ 32,368	$ 3,622	$ 99,613

v3.24.3

Summary of Significant Accounting Policies - Schedule of Property and Equipment Estimated Useful Lives (Details)	Sep. 30, 2024
Computers 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 years

v3.24.3

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, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Numerator:
Net loss	$ (26,429)	$ (35,077)	$ (97,007)	$ (100,942)
Less: Net loss attributable to noncontrolling interest	16	30	63	134
Net loss attributable to Alignment Healthcare, Inc.	$ (26,413)	$ (35,047)	$ (96,944)	$ (100,808)
Denominator:
Total weighted-average common shares outstanding - basic (in shares)	191,610,696	188,657,282	190,882,849	188,241,025
Total weighted-average common shares outstanding - diluted (in shares)	191,610,696	188,657,282	190,882,849	188,241,025
Less: Restricted shares of common stock (in shares)	(249,413)	(1,328,964)	(459,835)	(2,747,680)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic (in shares)	191,361,283	187,328,318	190,423,014	185,493,345
Total weighted-average common shares outstanding, net of restricted shares of common stock - diluted (in shares)	191,361,283	187,328,318	190,423,014	185,493,345
Net loss per share:
Net loss per share - basic (in dollars per share)	$ (0.14)	$ (0.19)	$ (0.51)	$ (0.54)
Net loss per share - diluted (in dollars per share)	$ (0.14)	$ (0.19)	$ (0.51)	$ (0.54)

v3.24.3

Summary of Significant Accounting Policies - Schedule of Computation of Diluted Net Loss Per Share (Details) - shares	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Antidilutive securities excluded from computation of earnings per share (in shares)	30,559,392	26,413,563
Stock options
Antidilutive securities excluded from computation of earnings per share (in shares)	8,846,955	10,272,029
Restricted stock units
Antidilutive securities excluded from computation of earnings per share (in shares)	21,712,437	16,141,534

v3.24.3

Fair Value - Schedule of Carrying Value and Fair Value of Financial Instruments (Details) - USD ($)	Sep. 30, 2024	Dec. 31, 2023
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	$ 74,980,000	$ 117,337,000
Certificate of deposits	2,302,000	1,755,000
Assets, fair value disclosure	77,282,000	119,092,000
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	75,034,000	117,310,000
Certificate of deposits	0	0
Assets, fair value disclosure	75,034,000	117,310,000
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	0	0
Certificate of deposits	2,302,000	1,755,000
Assets, fair value disclosure	2,302,000	1,755,000
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
U.S. Treasury bills	0	0
Certificate of deposits	0	0
Assets, fair value disclosure	$ 0	$ 0

v3.24.3

Fair Value - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Impairment charges	$ 645,000	$ 0	$ 645,000	$ 0	$ 0
Gross unrecognized gain	54,000		54,000
US Treasury Bill Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Restricted investments	1,016,000		1,016,000		1,423,000
Certificate of deposits
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Restricted investments	2,302,000		2,302,000		1,755,000
Short-Term Investments
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Treasury securities investments	40,676,000		40,676,000		115,914,000
Cash and Cash Equivalents
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Treasury securities investments	$ 33,288,000		$ 33,288,000		$ 22,232,000

v3.24.3

Accounts Receivable - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Government receivables	$ 25,161	$ 35,529
Pharmacy rebate receivables	104,917	75,894
Other receivables	8,897	8,326
Total accounts receivable	138,975	119,749
Allowance for credit losses	(123)	0
Accounts receivable, net	$ 138,852	$ 119,749

v3.24.3

Accounts Receivable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Credit loss related to accounts receivable	$ 28	$ 40	$ 123	$ 91

v3.24.3

Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Property Plant and Equipment [Line Items]
Subtotal	$ 207,448	$ 175,586
Less accumulated depreciation	(142,756)	(123,685)
Property and equipment-net	64,692	51,901
Computers and equipment
Property Plant and Equipment [Line Items]
Subtotal	11,942	11,447
Office equipment and furniture
Property Plant and Equipment [Line Items]
Subtotal	4,341	4,396
Software
Property Plant and Equipment [Line Items]
Subtotal	172,178	148,864
Leasehold improvements
Property Plant and Equipment [Line Items]
Subtotal	6,347	6,347
Construction in progress
Property Plant and Equipment [Line Items]
Subtotal	$ 12,640	$ 4,532

v3.24.3

Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Property Plant and Equipment [Line Items]
Depreciation expense	$ 7,036	$ 5,534	$ 19,552	$ 15,609
Medical expenses
Property Plant and Equipment [Line Items]
Depreciation expense	$ 46	$ 64	$ 144	$ 194

v3.24.3

Goodwill and Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Gross	$ 34,826	$ 34,826
Goodwill, Net	34,826	34,826
Finite-Lived Intangible Assets [Line Items]
Accumulated Amortization	(3,333)	(3,465)
Intangible Assets, Net (Including Goodwill) [Abstract]
Total	42,709	43,543
Accumulated Amortization	(3,333)	(3,465)
Goodwill	39,376	40,078
Plan member relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	2,700	2,700
Accumulated Amortization	(2,700)	(2,700)
Net Carrying Value	$ 0	$ 0
Weighted Average Life	9 years	9 years
Intangible Assets, Net (Including Goodwill) [Abstract]
Accumulated Amortization	$ (2,700)	$ (2,700)
Other
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	633	1,050
Accumulated Amortization	(633)	(765)
Net Carrying Value	0	285
Intangible Assets, Net (Including Goodwill) [Abstract]
Accumulated Amortization	$ (633)	$ (765)
Minimum | Other
Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	2 years	2 years
Maximum | Other
Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	10 years	10 years
License (indefinite lived)
Indefinite Lived Intangible Assets By Major Class [Line Items]
License (indefinite lived)	$ 4,550	$ 4,967

v3.24.3

Goodwill and Intangible Assets - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 650,000	$ 27,000	$ 702,000	$ 198,000
Impairment charges	$ 645,000	$ 0	$ 645,000	$ 0	$ 0

v3.24.3

Medical Expenses Payable - Schedule of Medical Expenses Payable (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023	Sep. 30, 2023	Dec. 31, 2022
Insurance [Abstract]
Claims incurred but not paid	$ 158,174	$ 95,664	$ 101,900	$ 88,813
Capitation and risk-sharing payable	42,239	50,894
Other	96,712	58,841
Medical expenses payable	$ 297,125	$ 205,399	$ 203,435

v3.24.3

Medical Expenses Payable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024
Insurance [Abstract]
Remaining claim amounts payment period		3 years
Claims reserve estimates, excluding provision	$ 548	$ 3,879

v3.24.3

Medical Expenses Payable - Schedule of Components of Change in Medical Expenses Payable (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Claims incurred but not paid - beginning balance	$ 95,664	$ 88,813
Incurred related to:
Current year	619,772	360,372
Prior years	(7,031)	(10,067)
Total incurred, net of reinsurance	612,741	350,305
Payments related to:
Current year	470,460	266,218
Prior years	79,771	71,000
Total payments, net of reinsurance	550,231	337,218
Claims incurred but not paid - ending balance	158,174	101,900
Capitation payable, risk-sharing payable, and other	138,951	101,535
Medical expenses payable	$ 297,125	$ 203,435	$ 205,399

v3.24.3

Long-Term Debt - Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
Long-term debt	$ 215,000	$ 165,000
Less unamortized debt issuance costs	(3,001)	(3,187)
Long-term debt-net of amortization	211,999	161,813
Less current maturities of long-term debt	(1,613)	0
Long-term debt - net of current portion	$ 210,386	$ 161,813

v3.24.3

Long-Term Debt - Additional Information (Details) - USD ($) $ in Thousands				9 Months Ended
	Jan. 01, 2025	Jun. 14, 2024	Sep. 02, 2022	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Debt Instrument [Line Items]
Long-term debt				$ 215,000		$ 165,000
Proceeds from long-term debt				50,000	$ 0
Debt issuance costs				$ 512	$ 0
Oxford Term Loan | Secured Debt
Debt Instrument [Line Items]
Debt instrument, face amount			$ 250,000
Long-term debt			$ 165,000
Debt interest floor rate			6.50%
Commitment fee			$ 1,650
Debt instrument origination fee			$ 1,650
Accrual interest rate on default			2.00%
Repayment limit on net proceeds from sale of asset			$ 2,500
Minimum liquidity in the loan agreement			$ 23,000
Oxford Term Loan | Secured Debt | Scenario Forecast
Debt Instrument [Line Items]
Credit facility, periodic principal payments	$ 538
Gross principal borrowed	0.25%
Oxford Term Loan | Secured Debt | Minimum
Debt Instrument [Line Items]
Interest rate during period				11.70%
Oxford Term Loan | Secured Debt | Maximum
Debt Instrument [Line Items]
Interest rate during period				11.85%
Oxford Term Loan | Secured Debt | Base Rate
Debt Instrument [Line Items]
Debt interest floor rate			1.00%
Delayed Draw Term Loan
Debt Instrument [Line Items]
Unused borrowing capacity, amount				$ 35
Delayed Draw Term Loan | Secured Debt
Debt Instrument [Line Items]
Additional term loan amount			$ 85,000
Proceeds from long-term debt		$ 50,000
Commitment fee			850
Debt instrument origination fee			500
Debt issuance costs			$ 1,096

v3.24.3

Long-Term Debt - Schedule of Future Maturities Under the Term Loan (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
Remainder of 2024	$ 0
2025	2,150
2026	2,150
2027	210,700
2028	0
Total	$ 215,000	$ 165,000

v3.24.3

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Operating Loss Carryforwards [Line Items]
Income tax expense	$ (8)	$ 0	$ 14	$ 2
NOL carryforwards indefinite life					$ 312,446
NOL carryforwards expiration year			2033
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Taxable income deduction limit percentage			80.00%
Carryforward offset percentage of taxable income	100.00%		100.00%
NOL carryforwards					504,097
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					$ 498,933

v3.24.3

Equity-Based Compensation - Additional Information (Details) - USD ($)						3 Months Ended		9 Months Ended
	Mar. 01, 2027	Dec. 31, 2025	Mar. 01, 2025	Mar. 13, 2024	Sep. 14, 2023	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2026	Dec. 31, 2024
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								$ 79,251,000
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%
RSUs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage								25.00%
Award vesting period								4 years
Performance-based Restricted Stock Units | Scenario Forecast
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage	100.00%	50.00%	50.00%
Performance target, health plan revenue growth percentage										50.00%	60.00%
Performance target, returning member medical benefit ratio											0.20
Performance target, adjusted earnings before interest, less capital expenditures											20.00%
Performance target, adjusted earnings before interest										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%	0.00%
Performance-based Restricted Stock Units | Maximum
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Annual award vesting rights, percentage				200.00%	150.00%
Non-vested awards RSAs, options and RSUs
Share Based Compensation Arrangement by Share Based Payment Award [Line Items]
Weighted average contractual term								1 year 7 months 13 days

v3.24.3

Equity-Based Compensation - Schedule of Stock Option Activity Transactions (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended			6 Months Ended	12 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2024	Dec. 31, 2023
Shares Subject to Options Outstanding
Options outstanding, beginning balance (in shares)	8,949,589	9,023,343	9,135,879	9,135,879
Options granted (in shares)	0	0	0
Options exercised (in shares)	0	0	0
Options forfeited / expired (in shares)	(102,634)	(73,754)	(112,536)
Options outstanding, ending balance (in shares)	8,846,955	8,949,589	9,023,343	8,949,589	9,135,879
Options outstanding, vested and exercisable (in shares)	6,164,008
Weighted- Average Exercise Price per Option
Options outstanding, beginning balance (in dollars per share)	$ 16.97	$ 16.97	$ 16.95	$ 16.95
Options granted (n dollars per share)	0	0	0
Options exercised (in dollars per share)	0	0	0
Options forfeited / expired (in dollars per share)	17.99	16.62	15.41
Options outstanding, ending balance (in dollars per share)	16.96	$ 16.97	$ 16.97	$ 16.97	$ 16.95
Options outstanding, vested and exercisable (in dollars per share)	$ 17.27
Stock Option Activity, Additional Disclosures
Weighted-average remaining contractual terms, outstanding	6 years 6 months 14 days		7 years 14 days	6 years 9 months 14 days	7 years 3 months 14 days
Weighted-average remaining contractual terms, vested and exercisable				6 years 6 months
Aggregate intrinsic value	$ 2,862	$ 27	$ 0	$ 27	$ 79
Aggregate intrinsic value, vested and exercisable	$ 1,427

v3.24.3

Equity-Based Compensation - Schedule of RSAs Transactions (Details) - Restricted Stock Awards - $ / shares	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested and outstanding, beginning balance (in shares)	537,242	540,298	683,953
Vested (in shares)	(479,847)	(3,056)	(140,856)
Forfeited (in shares)	0	0	(2,799)
Unvested and outstanding, ending balance (in shares)	57,395	537,242	540,298
Weighted-Average Grant Date Fair Value
Unvested and outstanding, beginning balance (in dollars per share)	$ 3.95	$ 3.94	$ 5.86
Vested (in dollars per share)	2.49	2.49	13.22
Forfeited (in dollars per share)	0	0	5.05
Unvested and outstanding, ending balance (in dollars per share)	$ 16.16	$ 3.95	$ 3.94

v3.24.3

Equity-Based Compensation - Schedule of RSU Transactions (Details) - RSUs - $ / shares	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested and outstanding, beginning balance (in shares)	14,018,273	14,390,497	10,541,625
Granted (in shares)	255,391	103,292	6,517,337
Vested (in shares)	(359,039)	(80,178)	(2,385,493)
Cancelled/forfeited (in shares)	(293,726)	(395,338)	(282,972)
Unvested and outstanding, ending balance (in shares)	13,620,899	14,018,273	14,390,497
Weighted-Average Grant Date Fair Value
Unvested and outstanding, beginning balance (in dollars per share)	$ 8.98	$ 8.97	$ 11.25
Granted (in dollars per share)	8.26	5.62	5.05
Vested (in dollars per share)	9.77	6.07	8.25
Cancelled/forfeited (in dollars per share)	7.86	8.40	9.36
Unvested and outstanding, ending balance (in dollars per share)	$ 8.97	$ 8.98	$ 8.97
Number of shares vested but issuance and delivery deferred (in shares)			107,948

v3.24.3

Equity-Based Compensation - Schedule of PSUs Transactions (Details) - Performance-based Restricted Stock Units - $ / shares	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested and outstanding, beginning balance (in shares)	8,178,205	8,376,538	7,233,205
Granted (in shares)	0	0	1,160,000
Vested (in shares)	0	0	0
Cancelled/forfeited (in shares)	(86,667)	(198,333)	(16,667)
Unvested and outstanding, ending balance (in shares)	8,091,538	8,178,205	8,376,538
Weighted-Average Grant Date Fair Value
Unvested and outstanding, beginning balance (in dollars per share)	$ 5.64	$ 5.64	$ 5.74
Granted (in dollars per share)	0	0	5.00
Vested (in dollars per share)	0	0	0
Cancelled/forfeited (in dollars per share)	5.74	5.67	5.74
Unvested and outstanding, ending balance (in dollars per share)	$ 5.64	$ 5.64	$ 5.64

v3.24.3

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, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 17,258	$ 13,569	$ 54,896	$ 51,183
Selling, general and administrative expenses
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	15,769	11,836	51,512	45,159
Medical expenses
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total equity-based compensation expense	$ 1,489	$ 1,733	$ 3,384	$ 6,024

v3.24.3

Commitments and Contingencies (Details) - USD ($) $ in Thousands	Aug. 15, 2023	Sep. 30, 2024	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Settlement amount	$ 913
Accrued for a potential liability		$ 913	$ 913

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