BENEFITS PAYABLE

12 Months Ended

Dec. 31, 2023

Reserves for medical claims expenses are estimated using actuarial assumptions and recorded as a benefits payable liability on the consolidated balance sheet. The assumptions for the estimates and for establishing the resulting liability are reviewed, and any adjustments to reserves are reflected in the consolidated statement of operations in the period in which the estimates are updated.

The following table provides a rollforward of the Company’s beginning and ending benefits payable and claims adjustment expenses ("CAE") payable balances for the years ended December 31, 2023, 2022 and 2021:


	Year Ended December 31, 2023
(in thousands)	Benefits Payable		Unallocated Claims Adjustment Expense		Total
Benefits payable, beginning of the period	$	937,727	$	12,712	$	950,439
Less: Reinsurance recoverable	277,944		—		277,944
Benefits payable, beginning of the period, net	$	659,783	$	12,712	$	672,495

Claims incurred and CAE
Current year	$	4,622,263	$	105,565	$	4,727,828
Prior years	19,761		—		19,761
Total claims incurred and CAE, net	$	4,642,024	$	105,565	$	4,747,589

Claims paid and CAE
Current year	$	3,840,009	$	94,807	$	3,934,816
Prior years	552,923		10,278		563,201
Total claims and CAE paid, net	$	4,392,932	$	105,085	$	4,498,017

Benefits and CAE payable, end of period, net	$	908,875	$	13,192	$	922,067
Add: Reinsurance recoverable	57,111		—		57,111
Benefits and CAE payable, end of period	$	965,986	$	13,192	$	979,178


	Year Ended December 31, 2022
(in thousands)	Benefits Payable		Unallocated Claims Adjustment Expense		Total
Benefits payable, beginning of the period	$	513,582	$	9,101	$	522,683
Less: Reinsurance recoverable	159,180		—		159,180
Benefits payable, beginning of the period, net	$	354,402	$	9,101	$	363,503

Claims incurred and CAE
Current year	$	3,279,460	$	117,541	$	3,397,001
Prior years	1,338		—		1,338
Total claims incurred and CAE, net	$	3,280,798	$	117,541	$	3,398,339

Claims paid and CAE
Current year	$	2,726,912	$	106,871	$	2,833,783
Prior years	248,505		7,059		255,564
Total claims and CAE paid, net	$	2,975,417	$	113,930	$	3,089,347

Benefits and CAE payable, end of period, net	$	659,783	$	12,712	$	672,495
Add: Reinsurance recoverable	277,944		—		277,944
Benefits and CAE payable, end of period	$	937,727	$	12,712	$	950,439


	Year Ended December 31, 2021
(in thousands)	Benefits Payable		Unallocated Claims Adjustment Expense		Total
Benefits payable, beginning of the period	$	311,914	$	5,509	$	317,423
Less: Reinsurance recoverable	132,658		—		132,658
Benefits payable, beginning of the period, net	$	179,256	$	5,509	$	184,765

Claims incurred and CAE
Current year	$	1,640,247	$	73,892	$	1,714,139
Prior years	(16,252)		—		(16,252)
Total claims incurred and CAE, net	$	1,623,995	$	73,892	$	1,697,887

Claims paid and CAE
Current year	$	1,346,870	$	64,791	$	1,411,661
Prior years	101,978		5,509		107,487
Total claims and CAE paid, net	$	1,448,848	$	70,300	$	1,519,148

Benefits and CAE payable, end of period, net	$	354,402	$	9,101	$	363,503
Add: Reinsurance recoverable	159,180		—		159,180
Benefits and CAE payable, end of period	$	513,582	$	9,101	$	522,683

Amounts incurred related to prior periods vary from previously estimated liabilities as more claim information becomes available and claims are ultimately settled.

Unallocated Claims Adjustment Expenses

Unallocated claims adjustment expenses (“CAE”) are costs incurred or expected to be incurred in connection with the adjustment and recording of health claims not subject to reinsurance. Such expenses include, but are not limited to, case management, utilization review, and quality assurance, and are intended to reduce the number of health services provided or the cost of such services. CAE is included in other insurance costs and the related CAE payable is included in accounts payable and accrued liabilities.

The following tables provide information about incurred, paid healthcare claims development, unpaid claims liability and cumulative claims frequency. The claims development information for all periods preceding the most recent reporting period is considered required unaudited supplementary information. For claims frequency information summarized below, a claim is defined as the financial settlement of a single medical event in which remuneration was paid to the servicing provider. Total IBNR plus expected development on reported claims represents estimates for claims incurred but not reported and development on reported claims. The Company estimates its 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 historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services, and other relevant factors.

Incurred Healthcare Claims

Net of Reinsurance


	Year Ended December 31,						IBNR		Cumulative number of reported claims (in thousands)
	(Unaudited)		(Unaudited)
(in thousands)	2021		2022		2023
Date of Service
2021	$	1,640,247	$	1,648,358	$	1,631,603	$	24,280	6,274
2022			3,279,461		3,314,332		90,415		12,725
2023					4,622,263		782,253		11,526
Total claims incurred					$	9,568,198

Cumulative Paid Healthcare Claims

Net of Reinsurance


	Year Ended December 31,

	(Unaudited)		(Unaudited)
(in thousands)	2021		2022		2023
Date of Service
2021	$	1,346,870	$	1,576,846	$	1,607,324
2022			2,726,912		3,223,917
2023					3,840,009
Total payment of incurred claims					8,671,250
All outstanding liabilities prior to 2021, net of reinsurance					11,927
Total benefits payable, net of reinsurance					$	908,875

The following table reconciles total outstanding liabilities, net of reinsurance to benefits payable in the consolidated balance sheet:


	As of December 31,
(in thousands)	2023		2022
Short-duration healthcare costs payable, net of reinsurance	$	908,875	$	659,783
Reinsurance recoverables	57,111		277,944
Total benefits payable	$	965,986	$	937,727