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Medical Claims Payable (Tables)

12 Months Ended

Dec. 31, 2021

Reconciliation Of The Beginning And Ending Balances For Medical Claims Payable

A reconciliation of the beginning and ending balances for medical claims payable, by segment (see Note 20, “Segment Information”), for the year ended December 31, 2021 is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Gross medical claims payable, beginning of year	$	3,294	$	7,646	$	195	$	11,135
Ceded medical claims payable, beginning of year	(13)		(33)		—		(46)
Net medical claims payable, beginning of year	3,281		7,613		195		11,089
Business combinations and purchase adjustments	—		375		45		420
Net incurred medical claims:
Current year	28,132		70,670		1,638		100,440
Prior years redundancies	(465)		(1,222)		(16)		(1,703)
Total net incurred medical claims	27,667		69,448		1,622		98,737
Net payments attributable to:
Current year medical claims	24,502		62,233		1,421		88,156
Prior years medical claims	2,612		6,054		163		8,829
Total net payments	27,114		68,287		1,584		96,985
Net medical claims payable, end of year	3,834		9,149		278		13,261
Ceded medical claims payable, end of year	13		8		—		21
Gross medical claims payable, end of year	$	3,847	$	9,157	$	278	$	13,282

A reconciliation of the beginning and ending balances for medical claims payable, by segment, for the year ended December 31, 2020 is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Gross medical claims payable, beginning of year	$	3,039	$	5,608	$	—	$	8,647
Ceded medical claims payable, beginning of year	(14)		(19)		—		(33)
Net medical claims payable, beginning of year	3,025		5,589		—		8,614
Business combinations and purchase adjustments	—		141		198		339
Net incurred medical claims:
Current year	24,894		58,912		1,288		85,094
Prior years redundancies	(375)		(262)		—		(637)
Total net incurred medical claims	24,519		58,650		1,288		84,457
Net payments attributable to:
Current year medical claims	21,736		51,602		1,291		74,629
Prior years medical claims	2,527		5,165		—		7,692
Total net payments	24,263		56,767		1,291		82,321
Net medical claims payable, end of year	3,281		7,613		195		11,089
Ceded medical claims payable, end of year	13		33		—		46
Gross medical claims payable, end of year	$	3,294	$	7,646	$	195	$	11,135

A reconciliation of the beginning and ending balances for medical claims payable, by segment, for the year ended December 31, 2019 is as follows:


	Commercial & Specialty Business		Government Business		Total
Gross medical claims payable, beginning of year	$	2,586	$	4,680	$	7,266
Ceded medical claims payable, beginning of year	(10)		(24)		(34)
Net medical claims payable, beginning of year	2,576		4,656		7,232

Net incurred medical claims:
Current year	25,942		52,753		78,695
Prior years redundancies	(190)		(310)		(500)
Total net incurred medical claims	25,752		52,443		78,195
Net payments attributable to:
Current year medical claims	23,026		47,268		70,294
Prior years medical claims	2,277		4,242		6,519
Total net payments	25,303		51,510		76,813
Net medical claims payable, end of year	3,025		5,589		8,614
Ceded medical claims payable, end of year	14		19		33
Gross medical claims payable, end of year	$	3,039	$	5,608	$	8,647

(Favorable) Unfavorable Developments By Changes In Key Assumptions

The following table provides a summary of the two key assumptions having the most significant impact on our incurred but not paid liability estimates for the years ended December 31, 2021, 2020 and 2019, which are the completion and trend factors. These two key assumptions can be influenced by utilization levels, unit costs, mix of business, benefit plan designs, provider reimbursement levels, processing system conversions and changes, claim inventory levels, claim processing patterns, claim submission patterns and operational changes resulting from business combinations. The impact from COVID-19 on healthcare utilization and medical claims submission patterns has increased estimation uncertainty on our incurred but not reported liability at December 31, 2021. Slowdowns in claims submission patterns and increases in utilization levels for COVID-19 testing and treatment during the fourth quarter of 2021 are the primary factors that lead to the increased estimation uncertainty.


	Favorable Developments by Changes in Key Assumptions
	2021		2020		2019
Assumed trend factors	$	(1,429)	$	(599)	$	(325)
Assumed completion factors	(274)		(38)		(175)
Total	$	(1,703)	$	(637)	$	(500)

Reconciliation of Net Incurred Medical Claims to Benefit Expense

The reconciliation of net incurred medical claims to benefit expense included in the consolidated statements of income is as follows:


	Years Ended December 31
	2021		2020		2019
Net incurred medical claims:
Commercial & Specialty Business	$	27,667	$	24,519	$	25,752
Government Business	69,448		58,650		52,443
Other	1,622		1,288		—
Total net incurred medical claims	98,737		84,457		78,195
Quality improvement and other claims expense	3,908		3,588		3,591
Benefit expense	$	102,645	$	88,045	$	81,786

Incurred and Paid Claims Development, Net of Reinsurance

Incurred claims development, net of reinsurance, for the Commercial & Specialty Business for the years ended December 31, 2021, 2020 and 2019 is as follows:


Commercial & Specialty Business	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2019		2020
Claim Years	(Unaudited)		(Unaudited)		2021
2019 & Prior	$	28,328	$	27,953	$	28,249
2020			24,894		24,133
2021					28,132
Total					$	80,514

Paid claims development, net of reinsurance, for the Commercial & Specialty Business for the years ended December 31, 2021, 2020 and 2019 is as follows:


Commercial & Specialty Business	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2019		2020
Claim Years	(Unaudited)		(Unaudited)		2021
2019 & Prior	$	25,303	$	27,830	$	28,216
2020			21,736		23,962
2021					24,502
Total					$	76,680

At December 31, 2021, the total of incurred but not reported liabilities plus expected development on reported claims for the Commercial & Specialty Business was $33, $171 and $3,630 for the claim years 2019 and prior, 2020 and 2021, respectively.

At December 31, 2021, the cumulative number of reported claims for the Commercial & Specialty Business was 91, 80 and 80 for the claim years 2019 and prior, 2020 and 2021, respectively.

Incurred claims development, net of reinsurance, for the Government Business as of and for the years ended December 31, 2021, 2020 and 2019 is as follows:


Government Business	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2019		2020
Claim Years	(Unaudited)		(Unaudited)		2021
2019 & Prior	$	57,099	$	56,837	$	56,537
2020			59,053		58,131
2021					71,045
Total					$	185,713

Paid claims development, net of reinsurance, for the Government Business as of and for the years ended December 31, 2021, 2020 and 2019 is as follows:


Government Business	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2019		2020
Claim Years	(Unaudited)		(Unaudited)		2021
2019 & Prior	$	51,510	$	56,675	$	56,447
2020			51,602		57,884
2021					62,233
Total					$	176,564

At December 31, 2021, the total of incurred but not reported liabilities plus expected development on reported claims for the Government Business was $90, $247 and $8,812 for the claim years 2019 and prior, 2020 and 2021, respectively.

At December 31, 2021, the cumulative number of reported claims for the Government Business was 253, 263 and 300 for the claim years 2019 and prior, 2020 and 2021, respectively.

Incurred claims development, net of reinsurance, for Other as of and for the years ended December 31, 2021, 2020 and 2019 is as follows:


Other	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2019		2020
Claim Years	(Unaudited)		(Unaudited)		2021
2019 & Prior	$	—	$	—	$	—
2020			1,486		1,470
2021					1,683
Total					$	3,153

Paid claims development, net of reinsurance, for Other as of and for the years ended December 31, 2021, 2020 and 2019 is as follows:


Other	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2019		2020
Claim Years	(Unaudited)		(Unaudited)		2021
2019 & Prior	$	—	$	—	$	—
2020			1,291		1,454
2021					1,421
Total					$	2,875

At December 31, 2021, the total of incurred but not reported liabilities plus expected development on reported claims for Other was $0, $16 and $262 for the claim years 2019 and prior, 2020 and 2021, respectively.

At December 31, 2021, the cumulative number of reported claims for Other was 0, 28, and 25 for the claim years 2019 and prior, 2020 and 2021, respectively.

Reconciliation Of Claims Development To The Claims Liability

The reconciliation of the Commercial & Specialty Business, Government Business and Other incurred and paid claims development information for the three years ended December 31, 2021, reflected in the tables above, to the consolidated ending balance for medical claims payable included in the consolidated balance sheet, as of December 31, 2021, is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Cumulative incurred claims and allocated claim adjustment expenses, net of reinsurance	$	80,514	$	185,713	$	3,153	$	269,380
Less: Cumulative paid claims and allocated claim adjustment expenses, net of reinsurance	76,680		176,564		2,875		256,119
Net medical claims payable, end of year	3,834		9,149		278		13,261
Ceded medical claims payable, end of year	13		8		—		21
Insurance lines other than short duration	—		236		—		236
Gross medical claims payable, end of year	$	3,847	$	9,393	$	278	$	13,518