Consolidated Statements of Operations and Comprehensive Income (USD $) In Thousands, except Per Share data, unless otherwise specified	3 Months Ended
	Mar. 31, 2013	Mar. 31, 2012
Operating revenues:
Managed care premiums	$ 3,236,663	$ 3,386,268
Management services	283,572	305,699
Total operating revenues	3,520,235	3,691,967
Operating expenses:
Medical costs	2,686,651	2,808,348
Cost of sales	59,485	67,952
Selling, general and administrative	520,300	502,888
Depreciation and amortization	37,631	36,303
Total operating expenses	3,304,067	3,415,491
Operating earnings	216,168	276,476
Interest expense	24,582	25,557
Other income, net	30,330	24,434
Earnings before income taxes	221,916	275,353
Provision for income taxes	86,547	104,634
Net earnings	135,369	170,719
Net earnings per common share:
Basic earnings per common share	$ 1.01	$ 1.21
Diluted earnings per common share	$ 1.00	$ 1.20
Cash dividends declared per share	$ 0.125	$ 0.125
Other Comprehensive Income, Net of Tax:
Change in unrealized investment holding gains	(10,326)	7,537
Reclassification adjustment, net	(12,513)	(4,339)
Income tax benefit (provision)	7,376	(2,732)
Other Comprehensive Income, Net of Tax	(15,463)	466
Comprehensive income	$ 119,906	$ 171,185