Liability for Unpaid Claims - Summary of Liability for Unpaid Health Claims (Details) - Health claims - USD ($) $ in Thousands	12 Months Ended
Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Activity in the Liability for Unpaid Health Claims
Beginning balance	$ 167,832	$ 162,261	$ 163,808
Incurred related to:
Current year	675,785	638,054	584,936
Prior years	(15,631)	(22,477)	(14,829)
Total incurred	660,154	615,577	570,107
Paid related to:
Current year	517,855	487,096	442,127
Prior year	131,610	122,910	129,527
Total paid	649,465	610,006	571,654
Ending balance	$ 178,521	$ 167,832	$ 162,261

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Amount, after effects of reinsurance, of payments to settle claims incurred in the current period and related claims settlement costs.

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Amount, after effects of reinsurance, of payments to settle claims incurred in prior periods and related claims settlement costs.

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Amount, after effects of reinsurance, of expense (reversal of expense) for claims incurred and costs incurred in the claim settlement process.

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Liability as of the balance sheet date for amounts representing estimated cost of settling unpaid claims under the terms of the underlying insurance policies, less estimated reinsurance recoveries on such claims. This includes an estimate for claims which have been incurred but not reported. Claim adjustment expenses represent the costs estimated to be incurred in the settlement of unpaid claims.

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A roll forward is a reconciliation of a concept from the beginning of a period to the end of a period.

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Amount, after effects of reinsurance, of payments to settle insured claims and pay costs incurred in the claims settlement process.

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Amount, after effects of reinsurance, of expense for claims incurred in the current reporting period and related claims settlement costs.

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