Medical Claims Payable

6 Months Ended

Jun. 30, 2021

Liability for Claims and Claims Adjustment Expense [Abstract]

Medical Claims Payable

A reconciliation of the beginning and ending balances for medical claims payable, by segment (see Note 15, “Segment Information”), for the six months ended June 30, 2021 is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Gross medical claims payable, beginning of period	$	3,294	$	7,646	$	195	$	11,135
Ceded medical claims payable, beginning of period	(13)		(33)		—		(46)
Net medical claims payable, beginning of period	3,281		7,613		195		11,089
Business combinations and purchase adjustments	—		375		45		420
Net incurred medical claims:
Current period	13,360		34,232		751		48,343
Prior periods redundancies	(570)		(1,190)		(12)		(1,772)
Total net incurred medical claims	12,790		33,042		739		46,571
Net payments attributable to:
Current period medical claims	10,295		26,647		591		37,533
Prior periods medical claims	2,154		5,455		158		7,767
Total net payments	12,449		32,102		749		45,300
Net medical claims payable, end of period	3,622		8,928		230		12,780
Ceded medical claims payable, end of period	11		30		—		41
Gross medical claims payable, end of period	$	3,633	$	8,958	$	230	$	12,821

At June 30, 2021, the total of net incurred but not reported liabilities plus expected development on reported claims for the Commercial & Specialty Business was $71, $486 and $3,065 for the claim years 2019 and prior, 2020 and 2021, respectively.

At June 30, 2021, the total of net incurred but not reported liabilities plus expected development on reported claims for the Government Business was $105, $862 and $7,961 for the claim years 2019 and prior, 2020 and 2021, respectively.

At June 30, 2021, the total of net incurred but not reported liabilities plus expected development on reported claims for Other was $0, $25 and $205 for the claim years 2019 and prior, 2020 and 2021, respectively.

A reconciliation of the beginning and ending balances for medical claims payable, by segment (see Note 15, “Segment Information”), for the six months ended June 30, 2020 is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Gross medical claims payable, beginning of period	$	3,039	$	5,608	$	—	$	8,647
Ceded medical claims payable, beginning of period	(14)		(19)		—		(33)
Net medical claims payable, beginning of period	3,025		5,589		—		8,614
Business combinations and purchase adjustments	—		141		198		339
Net incurred medical claims:
Current period	11,318		28,162		498		39,978
Prior periods redundancies	(374)		(326)		—		(700)
Total net incurred medical claims	10,944		27,836		498		39,278
Net payments attributable to:
Current period medical claims	9,014		22,115		496		31,625
Prior periods medical claims	2,218		4,823		—		7,041
Total net payments	11,232		26,938		496		38,666
Net medical claims payable, end of period	2,737		6,628		200		9,565
Ceded medical claims payable, end of period	62		28		—		90
Gross medical claims payable, end of period	$	2,799	$	6,656	$	200	$	9,655

The favorable development recognized in the six months ended June 30, 2021 and 2020 resulted primarily from trend factors in late 2020 and late 2019, respectively, developing more favorably than originally expected. Favorable development in the completion factors resulting from the latter parts of 2020 and 2019, respectively, developing faster than expected also contributed to the favorability. The impact from COVID-19 on healthcare utilization and medical claims submission patterns continues to provide increased estimation uncertainty on our incurred but not reported liability at June 30, 2021.

The reconciliation of net incurred medical claims to benefit expense included in our consolidated statements of income for periods in 2021 is as follows:




	Three Months Ended				Six Months Ended June 30, 2021
	March 31, 2021		June 30, 2021

Net incurred medical claims:
Commercial & Specialty Business	$	6,072	$	6,718		$	12,790
Government Business	16,319		16,723			33,042
Other	336		403			739
Total net incurred medical claims	22,727		23,844			46,571
Quality improvement and other claims expense	972		919			1,891
Benefit expense	$	23,699	$	24,763		$	48,462

The reconciliation of net incurred medical claims to benefit expense included in our consolidated statements of income for periods in 2020 is as follows:




	Three Months Ended				Six Months Ended June 30, 2020
	March 31, 2020		June 30, 2020

Net incurred medical claims:
Commercial & Specialty Business	$	5,797	$	5,147		$	10,944
Government Business	14,603		13,233			27,836
Other	130		368			498
Total net incurred medical claims	20,530		18,748			39,278
Quality improvement and other claims expense	959		799			1,758
Benefit expense	$	21,489	$	19,547		$	41,036

The reconciliation of the medical claims payable reflected in the tables above to the consolidated ending balance for medical claims payable included in the consolidated balance sheet, as of June 30, 2021, is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Net medical claims payable, end of period	$	3,622	$	8,928	$	230	$	12,780
Ceded medical claims payable, end of period	11		30		—		41
Insurance lines other than short duration	—		255		—		255
Gross medical claims payable, end of period	$	3,633	$	9,213	$	230	$	13,076