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2025年12月31日に終了した会計年度

～から～への移行期間において

Commission file number: 001-16751

(本社所在地） （郵便番号）

登録者の電話番号（市外局番を含む）：(833) 401-1577

法第12条(g)項に基づき登録された有価証券：なし

登録者が証券法第405条に定義される著名な経験豊富な発行者である場合は、チェックマークで示してください。はい x いいえ ¨

登録者が法第13条または第15条(d)に基づき報告書の提出を要しない場合は、チェックマークで示してください。はい ¨ いいえ x

登録者が（1）過去12か月間（または登録者が当該報告書を提出する必要があったより短い期間）に、1934年証券取引法第13条または第15条(d)に基づき提出が義務付けられているすべての報告書を提出したか、および（2）過去90日間、当該提出要件の対象となっていたかを、チェックマークで示してください。はい　×　いいえ　○

登録者が過去12か月間（または当該登録者が当該ファイルを提出する必要があったより短い期間）において、規則S-T第405条（本章§232.405）に基づき提出が義務付けられているすべてのインタラクティブデータファイルを電子的に提出したかどうかを、チェックマークで示してください。はい　x　いいえ　¨

登録者が大規模加速提出者、加速提出者、非加速提出者、小規模報告会社、または新興成長会社のいずれかに該当するかをチェックマークで示してください。「大規模加速提出者」、「加速提出者」、「小規模報告会社」、「新興成長会社」の定義については、証券取引法規則12b-2を参照してください。

新興成長企業の場合、登録者が証券取引法第13条(a)に基づき提供される新規または改訂された財務会計基準への準拠について延長移行期間を利用しないことを選択した場合は、チェックマークで示してください。

登録者が、財務報告に関する内部統制の有効性に関する経営陣の評価について、サーベンス・オクスリー法第404条(b)項（15 U.S.C. 7262(b)）に基づく報告書及び宣誓供述書を、監査報告書を作成または発行した登録公認会計士事務所により提出したかどうかを、チェックマークで示してください。 x

証券が法第12条(b)に基づき登録されている場合、提出書類に含まれる登録者の財務諸表が、以前に発行された財務諸表の誤りを修正したものであるかどうかを、チェックマークで示してください。

該当する修正事項のうち、登録企業の役員が関連する回収期間中に受け取ったインセンティブ報酬について、§240.10D-1(b)に基づき回収分析を必要とする再表示が含まれる場合は、チェックマークで明示すること。

登録者が（証券取引法第12b-2条に定義される）ペーパーカンパニーである場合はチェックマークで示してください。はい ☐いいえ x

登録者の非関連者が保有する議決権付き普通株式及び議決権なし普通株式の合計時価総額は、2025年6月30日現在、約87,349,478,366ドルであった（本計算の目的上、登録者の全取締役及び執行役員が「関連者」であると仮定）。

2026年2月1日現在、登録者の普通株式の発行済株式数は220,704,667株であった。

本10-K年次報告書の第III部には、2026年5月13日に開催予定の定時株主総会に関する登録者の確定委任状説明書からの情報が参照により組み込まれている。

 

 

 

パートI

ITEM 1.

ビジネス

3

ITEM 1A.

リスク要因

24

ITEM 1B.

未解決のスタッフコメント

39

ITEM 1C.

サイバーセキュリティ

39

ITEM 2.

プロパティ

40

ITEM 3.

法的手続き

41

ITEM 4.

鉱山安全開示事項

41

第II部

ITEM 5.

登録者の普通株式市場、関連する株主事項及び発行者による株式証券の買付

42

ITEM 6.

[予約済み]

43

ITEM 7.

経営陣による財務状況及び経営成績の分析と検討

44

ITEM 7A.

市場リスクに関する定量的および定性的開示

66

ITEM 8.

財務諸表及び補足データ

68

ITEM 9.

会計および財務開示に関する会計士との変更点および意見の相違

129

ITEM 9A.

管理と手順

129

ITEM 9B.

その他の情報

132

ITEM 9C.

外国管轄区域における検査妨害に関する開示

132

第III部

ITEM 10.

取締役、執行役員及びコーポレート・ガバナンス

132

ITEM 11.

役員報酬

132

ITEM 12.

特定実質所有者及び経営陣の有価証券所有権並びに関連する株主事項

132

ITEM 13.

特定の関係及び関連取引並びに取締役の独立性

133

ITEM 14.

主任会計士報酬及びサービス

133

第4部

ITEM 15.

別紙及び財務諸表明細書

134

ITEM 16.

FORM 10-K SUMMARY

139

署名

146

This document contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements reflect our views about future events and financial performance and are generally not historical facts. Words such as “expect,” “feel,” “believe,” “will,” “may,” “should,” “anticipate,” “intend,” “estimate,” “project,” “forecast,” “plan,” “potential,” “predict” and similar expressions are intended to identify forward-looking statements. These statements include, but are not limited to: financial projections and estimates and their underlying assumptions; statements regarding plans, objectives and expectations with respect to future operations, products and services; and statements regarding future performance. Such statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond our control, that could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. You are cautioned not to place undue reliance on these forward-looking statements that speak only as of the date hereof. You are also urged to carefully review and consider the various risks and other disclosures discussed in our reports filed with the U.S. Securities and Exchange Commission from time to time, which attempt to advise interested parties of the factors that affect our business. Except to the extent required by law, we do not update or revise any forward-looking statements to reflect events or circumstances occurring after the date hereof. These risks and uncertainties include, but are not limited to: trends in healthcare costs and utilization rates; reduced enrollment; our ability to secure and implement sufficient premium rates; the impact of large scale medical emergencies, such as public health epidemics and pandemics, and other catastrophes; the impact of new or changes in existing federal, state and international laws or regulations, including laws and regulations impacting healthcare, insurance, pharmacy services and other diversified products and services, or their enforcement or application; the impact of cyber-attacks or other privacy or data security incidents or our failure to comply with any privacy, data or security laws or regulations, including any investigations, claims or litigation related thereto; failure to effectively maintain and modernize our information systems; failure of our information systems or technology, including artificial intelligence, to operate as intended; failure to effectively maintain the availability and integrity of our data; changes in economic and market conditions, as well as regulations that may negatively affect our liquidity and investment portfolios; competitive pressures and our ability to adapt to changes in the industry and develop and implement strategic growth opportunities; risks and uncertainties regarding Medicare and Medicaid programs, including those related to non-compliance with the complex regulations imposed thereon; our ability to maintain and achieve improvement in Centers for Medicare and Medicaid Services Star Ratings and other quality scores and funding risks with respect to revenue received from participation therein; a negative change in our healthcare product mix; costs and other liabilities associated with litigation, government investigations, audits or reviews; our ability to contract with providers on cost-effective and competitive terms; risks associated with providing healthcare, pharmacy and other diversified products and services, including medical malpractice or professional liability claims and non-compliance by any party with the pharmacy services agreement between us and CaremarkPCS Health, L.L.C.; the effects of any negative publicity or sentiment related to the health benefits industry in general or us in particular; risks associated with mergers, acquisitions, joint ventures and strategic alliances; possible impairment of the value of our intangible assets if future results do not adequately support goodwill and other intangible assets; possible restrictions in the payment of dividends from our subsidiaries and increases in required minimum levels of capital; our ability to repurchase shares of our common stock and pay dividends on our common stock due to the adequacy of our cash flow and earnings and other considerations; the potential negative effect from our substantial amount of outstanding indebtedness and the risk that increased interest rates or market volatility could impact our access to or further increase the cost of financing; a downgrade in our financial strength ratings; events that may negatively affect our licenses with the Blue Cross and Blue Shield Association; intense competition to attract and retain employees; risks associated with our international operations; and various laws and provisions in our governing documents that may prevent or discourage takeovers and business combinations.

エレバンス・ヘルスおよびその直接・間接子会社（本文書では「当社」「当社グループ」「当社企業」「エレバンス・ヘルス」と総称）は、「高める（elevate）」と「進歩させる（advance）」の概念を融合させた先進的ヘルスケア企業です。当社は、ケアの全過程にわたる統合的かつ包括的なヘルスソリューションを提供することで、ウェルビーイングの向上と健康成果の促進に注力しています。 当社は、医療・薬剤・行動医療サービスを通じて、消費者の包括的な健康ニーズに対応し、その生涯にわたる健康の旅路を支援します。この包括的アプローチにより、サービスを提供する人々やコミュニティの健康向上を目指しています。医療提供者や地域組織との連携、成長と健康アクセス機会の均等を支えるイノベーションの促進、そして高パフォーマンス文化の醸成を通じて、当社の使命を推進しています。

多様な顧客のニーズに応えるという揺るぎない姿勢のもと、私たちは以下の価値観を指針としています：

当社は医療会員数において米国最大級の健康保険会社の一つであり、2025年12月31日現在、関連健康保険プランを通じて約4,520万人の医療会員にサービスを提供しています。個人、雇用主グループ、メディケイド、メディケア市場向けに、ネットワークベースのリスクベース管理医療プランを幅広く提供しています。 さらに、請求処理、ストップロス保険、医療提供者ネットワークへのアクセス、医療管理、ケアマネジメント、ウェルネスプログラム、アクチュアリーサービス、その他の管理サービスなど、幅広いマネージドケアサービスをフィーベースの顧客に提供しています。これらの市場全体で、当社はリスクベースの保険料、自己資金による雇用主からの管理手数料、およびCarelon事業を通じた薬局および医療サービス手数料を通じて収益を上げています。 当社は連邦政府に対し、連邦職員健康保険プログラム®（FEP®）を運営する連邦健康製品・サービス事業に関連したサービスを提供しています。子会社の健康保険プランの顧客および非提携健康保険プランに対し、薬局サービス、ストップロス保険、歯科・視力・補足医療保険給付、統合医療サービスなど、多様な専門サービスを提供しています。

当社は、独立した医療給付プランの連合体であるブルークロス・ブルーシールド協会（以下「BCBSA」）の独立ライセンス契約者です。カリフォルニア州ではブルークロス・ライセンス契約者として、コロラド州、コネチカット州、ジョージア州、インディアナ州、ケンタッキー州、メイン州、ミズーリ州（カンザスシティ地域の30郡を除く）、 ネバダ州、ニューハンプシャー州、ニューヨーク州（ニューヨーク市大都市圏およびニューヨーク州北部）、オハイオ州、バージニア州（ワシントンD.C.北部のバージニア郊外を除く）、ウィスコンシン州において、ブルークロス・ブルーシールドのライセンス事業体として会員にサービスを提供しています。これらのサービス地域の大半では、アンセム・ブルークロスおよびアンセム・ブルークロス・ブルーシールドとして事業を展開しています。また、他のBCBSライセンス事業体やその他の戦略的パートナーとの提携を通じて事業を行っています。 さらに、ウェルポイント、ケアロン、MMM、および／またはシンプリー・ヘルスケアとして多数の州で会員にサービスを提供しています。子会社を通じて、全50州、コロンビア特別区、プエルトリコで保険事業を行う認可を取得しています。複数の子会社を通じて、ケアロンRx事業による薬局サービスや、ケアロン・サービスとしてのその他の医療関連サービスも提供しています。

•アンセム・ブルークロス／アンセム・ブルークロス・アンド・ブルーシールド — 当社のアンセムブランドおよび提携先のブルークロスおよび／またはブルーシールドが認可するメディケア、メディケイド、および商業健康保険プランを表します；

•ウェルポイント — 当社のウェルポイントブランドのメディケア、メディケイド、および商業健康保険プラン、ならびにその他の非BCBSAブランドを表します；および

•カレロン — 当社が提供する医療関連サービスおよび能力を表し、カレロンRxおよびカレロン・サービス事業を含みます。

追加の説明については、本「事業」セクション内の「報告セグメント」および、本10-K年次報告書第II部第8項に含まれる連結財務諸表注記の注記1「組織」ならびに注記20「セグメント情報」を参照のこと。

医療は地域に根ざしたものであると私たちは考えています。広範な地域拠点網により、当社に登録されたあらゆる製品に関する顧客の進化するニーズに対応できる立場にあります。革新的で手頃な価格の選択肢豊富な製品、差別化されたサービス、簡素化された取引、質の高い医療を支える情報へのアクセス向上を提供することを目指しています。 地域市場への注力と全国規模の事業基盤を組み合わせることで、臨床品質・卓越性・費用対効果の高い実践を評価するプログラムにおいて医師や病院と連携できます。適切なタイミングで適切な環境下で適切な医療を提供するためのインセンティブを調整する、価値に基づく支払いモデルを推進し続けています。対象を絞ったアプローチにより、医療提供者を適切な経済的インセンティブと支援に結び付け、医療の質と健康成果の向上を促進します。 あらゆる支払いモデルにおける医療提供者と積極的に連携し、会員のより良い成果達成を支援しています。加えて、全国規模のネットワークと最適化されたサービスパフォーマンスを通じ、顧客への効率化を追求します。最後に、事業・製品ポートフォリオの合理化を継続し、投資を最適化して中核事業を強化、高成長機会への投資を推進、拡大した能力とサービスを通じた価値創出を加速させる方針です。

当社の業績は、効果的な医療提供者との契約、製品価格設定、医療管理、健康増進プログラム（複雑かつ専門的な医療ニーズに対するサービス調整やケースマネジメントを含む）を通じて、医療費を正確に予測し効果的に管理する能力に大きく依存しています。また、当社の業績は、メディケア・メディケイドサービスセンター（CMS）のスター評価プログラムにおける当社の実績にも影響を受けます。この評価は、メディケア・アドバンテージ・プランの償還額に影響を与えるだけでなく、当該プランにおける品質に基づくボーナス支払いの獲得資格にも影響を及ぼします。 当社のCMSスター評価に関する詳細は、本「事業」セクション内の「規制」を参照のこと。 当社のネットワークおよび医療提供者関係、製品価格設定、医療費管理プログラムに関する詳細は、本「事業」セクション内の「当社製品の価格設定と引受基準」、「ネットワークと提供者関係」、「医療管理プログラム」、「ケア管理およびウェルネス製品・プログラム」、「医療品質向上イニシアチブ」を参照のこと。

医療技術の進歩、処方薬の利用状況の変化、人口動態の傾向、規制の変更が、医療費の上昇要因として継続的に作用しています。当社のマネージドケアプランは、最適化された医療提供者ネットワーク、成果に基づく財務インセンティブ、効果的な医療管理支援を通じて、会員に高品質で費用対効果の高い医療給付プログラムを提供するように設計されています。 競争力のある費用対効果の高い製品を維持する当社の能力は、規律ある内部コスト管理、慎重なリスク管理、および買収事業の成功した統合によって支えられています。営業費用の管理は、当社の全体的な収益性にとって依然として極めて重要です。

当社の将来の業績は、連邦および州レベルにおける法規制環境の変化、利用可能な補助金、税金および手数料の変更によっても影響を受けます。詳細な議論については、本「事業」セクション内の「規制」および本10-K年次報告書に含まれる第I部項目1A「リスク要因」を参照してください。

当社の業績は、会員数および会員構成の変化にも影響を受けます。この変化は、当社の医療給付商品・サービスの価格設定、メディケイドの再認定、高齢化、医療利用パターン、従来無保険だった会員の医療システムへの参入、提供者および会員による不正行為、経済状況、失業率の変化、大規模緊急事態の継続的・将来的な影響、買収、新規市場への参入、既存市場における拡大または撤退などにより生じ、今後も変化し続ける見込みです。 これらの会員動向は、事業破綻を招く景気後退、新規顧客の獲得または既存顧客の維持の失敗、保険料の値上げ、給付内容の変更、会員の医療サービス利用方法の変化、特定市場からの撤退など、当社の将来の経営成績に重大な悪影響を及ぼし得る様々な要因により、悪影響を受ける可能性があります。 本10-K年次報告書に含まれる第I部項目1A「リスク要因」および第II部項目7「経営陣による財務状況および経営成績の分析」を参照のこと。

当社は、流通、サービス、臨床調整、管理効率を支援する先進的なツールを含む技術的ソリューションと業務改善を通じて、お客様、医療提供者、ブローカー、代理店、従業員、その他のステークホルダーとの連携を継続的に強化しています。

当社が参加する様々な連邦政府プログラムを通じて、2025年12月31日、2024年12月31日、2023年12月31日終了年度において、米国政府機関からの売上高は、それぞれ連結総収益の約32％、31％、29％を占めました。これらの収益の大部分は、後述する医療給付セグメントに含まれています。 当社の連結総収益のうち、米国およびプエルトリコ以外の地域における活動から得られる収益は、重要性を欠く金額です。

当社は、以下の4つの報告セグメントにおける業績を報告します：ヘルスベネフィット、ケアロンRx、ケアロンサービス、およびコーポレート・その他（個別に報告セグメントの定量的基準を満たさない事業、ならびに他の報告セグメントに配分されていない特定の企業レベルのコーポレート経費を含みます）。

当社の健康保険事業部門は、個人会員、雇用主グループ向けリスクベース契約、雇用主グループ向けフィーベース契約、BlueCard®、メディケア、メディケイド、FEP®会員に対し、包括的な健康保険プランとサービスを提供しています。健康保険事業部門は、フルリスクベースで健康保険商品を提供し、フィーベース契約の顧客には幅広い管理医療サービスを提供するとともに、ストップロス保険、歯科保険、視力保険、補足医療保険などの各種専門保険商品・サービスを提供しています。 当社のヘルスベネフィット部門の業績に影響を与える主な要因には、会員数および会員の健康状態、保険料価格設定、医療費動向、ネットワークパフォーマンス、リスク調整の精度、品質評価、運営効率などが含まれます。この部門は、医療費・薬剤費管理、ケア調整、行動医療、分析を支援する当社のケアロン事業との連携により利益を得ています。

当社のCarelonRxセグメントには、薬局サービス事業が含まれます。CarelonRxは、当社が所有する健康保険プランの外部顧客に加え、提携する健康保険プランの顧客に対し、薬局サービスの販売および提供を行っています。CarelonRxは包括的な薬局サービスポートフォリオを提供しており、これには宅配サービスや専門薬局といった中核的な薬局サービス、請求審査、処方薬リスト管理、薬局ネットワーク、リベート管理、処方薬データベース、会員サービスなどが含まれます。 さらに、2024年3月にParagon Healthcare, Inc.及びその子会社の買収によりポートフォリオに追加された外来点滴センターもCarelonRxに含まれます。CarelonRxは、薬局業務、専門医薬品管理、臨床プログラムを当社の包括的な総合医療モデルと統合することで、会員の医療費負担軽減と治療成果の向上に貢献しています。 本セグメントの業績に影響を与える主な要因には、専門医薬品の動向、処方箋数量、臨床プログラムの導入状況、ネットワーク最適化、リベート・価格戦略、および業務実績が含まれます。

当社のケアロン・サービス部門は、身体的ケア、行動ケア、薬剤ケア、社会ケアの機能を統合し、ケアロン・ヘルスおよびケアロン・インサイト事業を通じて、包括的なヘルスケアサービスを提供するとともに、社内外の顧客双方にとっての費用対効果向上を支援します。 当社のケアロン事業は、医療システムの複雑な領域を管理し、データと知見を活用することで、会員が安全で適切かつ高品質なケアを受けられる方法と、提供者への正確かつタイムリーな償還を改善し、手頃な価格を実現します。コスト管理へのアプローチは、プロバイダー支援、価値ベースネットワーク、会員エンゲージメント、利用管理などの能力に依存しています。 当社のケア提供サービスは、主に在宅および仮想環境での個別化ケアを通じて、慢性疾患や複雑な病状を抱える患者層を対象としています。Carelon Healthの一環として、2024年末にRSV QOZB LTSS, Inc.および関連会社（商号：CareBridge）の買収を完了しました。同社は複雑なメディケイド・メディケア患者への仮想ケアを提供し、在宅・地域基盤型サービスの管理において保険プランを支援しています。 本セグメントの業績に影響を与える主な要因には、ケアマネジメントおよび行動医療機能の拡充、価値基盤型ネットワークの拡大、医療提供者支援体制の強化、デジタル／仮想ケアモデルの推進、ならびに分析駆動型サービスの拡張性が含まれます。

None.