
	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


	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


	Commercial & Specialty Business		Government Business		Total
Gross medical claims payable, beginning of year	$	3,383	$	4,431	$	7,814
Ceded medical claims payable, beginning of year	(78)		(27)		(105)
Net medical claims payable, beginning of year	3,305		4,404		7,709
Business combinations and purchase adjustments	—		199		199
Net incurred medical claims:
Current year	24,094		45,487		69,581
Prior years redundancies	(456)		(474)		(930)
Total net incurred medical claims	23,638		45,013		68,651
Net payments attributable to:
Current year medical claims	21,633		41,115		62,748
Prior years medical claims	2,734		3,845		6,579
Total net payments	24,367		44,960		69,327
Net medical claims payable, end of year	2,576		4,656		7,232
Ceded medical claims payable, end of year	10		24		34
Gross medical claims payable, end of year	$	2,586	$	4,680	$	7,266

Amounts incurred related to prior years vary from previously estimated liabilities as the claims are ultimately settled. Liabilities at any period-end are continually reviewed and re-estimated as information regarding actual claims payments, or runout, becomes known. This information is compared to the originally established year end liability. Negative amounts reported for incurred medical claims related to prior years result from claims being settled for amounts less than originally estimated. The prior year redundancy of $637 shown above for the year ended December 31, 2020 represents an estimate

based on paid claim activity from January 1, 2020 to December 31, 2020. Medical claim liabilities are usually described as having a “short tail,” which means that they are generally paid within twelve months of the member receiving service from the provider. Accordingly, the majority of the $637 redundancy relates to claims incurred in calendar year 2019.

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, 2020, 2019 and 2018, 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, 2020. Slowdowns in claims submission patterns and increases in utilization levels for COVID-19 testing and treatment during the fourth quarter of 2020 are the primary factors that lead to the increased estimation uncertainty.

The favorable development recognized in 2020 resulted primarily from trend factors in late 2019 developing more favorably than originally expected as well as a smaller contribution from completion factor development.

The favorable development recognized in 2019 resulted primarily from trend in late 2018 developing more favorably than originally expected as well as a smaller but significant contribution from completion factor development.


	Years Ended December 31
	2020		2019		2018
Net incurred medical claims:
Commercial & Specialty Business	$	24,519	$	25,752	$	23,638
Government Business	58,650		52,443		45,013
Other	1,288		—		—
Total net incurred medical claims	84,457		78,195		68,651
Quality improvement and other claims expense	3,588		3,591		3,244
Benefit expense	$	88,045	$	81,786	$	71,895


Commercial & Specialty Business	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2018		2019
Claim Years	(Unaudited)		(Unaudited)		2020
2018 & Prior	$	26,943	$	26,753	$	26,747
2019			25,942		25,572
2020					24,894
Total					$	77,213


Commercial & Specialty Business	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2018		2019
Claim Years	(Unaudited)		(Unaudited)		2020
2018 & Prior	$	24,367	$	26,643	$	26,721
2019			23,026		25,475
2020					21,736
Total					$	73,932

At December 31, 2020, the total of incurred but not reported liabilities plus expected development on reported claims for the Commercial & Specialty Business was $26, $97 and $3,158 for the claim years 2018 and prior, 2019 and 2020, respectively.


Government Business	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2018		2019
Claim Years	(Unaudited)		(Unaudited)		2020
2018 & Prior	$	49,616	$	49,306	$	49,278
2019			52,753		52,518
2020					59,053
Total					$	160,849


Government Business	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2018		2019
Claim Years	(Unaudited)		(Unaudited)		2020
2018 & Prior	$	44,959	$	49,201	$	49,231
2019			47,269		52,403
2020					51,602
Total					$	153,236

At December 31, 2020, the total of incurred but not reported liabilities plus expected development on reported claims for the Government Business was $47, $115 and $7,451 for the claim years 2018 and prior, 2019 and 2020, respectively.


Other	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2018		2019
Claim Years	(Unaudited)		(Unaudited)		2020
2018 & Prior	$	—	$	—	$	—
2019			—		—
2020					1,486
Total					$	1,486


Other	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2018		2019
Claim Years	(Unaudited)		(Unaudited)		2020
2018 & Prior	$	—	$	—	$	—
2019			—		—
2020					1,291
Total					$	1,291

At December 31, 2020, the total of incurred but not reported liabilities plus expected development on reported claims for Other was $0, $0 and $195 for the claim years 2018 and prior, 2019 and 2020, respectively.

The information about incurred claims development, paid claims development and cumulative number of reported claims for the years ended December 31, 2018 and 2019 for our Commercial & Specialty Business, Government Business and Other, is unaudited and presented as supplementary information.

The cumulative number of reported claims for each claim year for our Commercial & Specialty Business, Government Business and Other have been developed using historical data captured by our claim payment systems. The provided claim

amounts are not a precise tool for understanding utilization of medical services. They could be impacted by a variety of factors including changes in provider billing practices, provider reimbursement arrangements, mix of services, benefit design or processing systems. The cumulative number of reported claims has been provided to comply with FASB accounting standards and is not used by management in its claims analysis. Our cumulative number of reported claims may not be comparable to similar measures reported by other health benefits companies.

The reconciliation of the Commercial & Specialty Business, Government Business and Other incurred and paid claims development information for the three years ended December 31, 2020, reflected in the tables above, to the consolidated ending balance for medical claims payable included in the consolidated balance sheet, as of December 31, 2020, is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Cumulative incurred claims and allocated claim adjustment expenses, net of reinsurance	$	77,213	$	160,849	$	1,486	$	239,548
Less: Cumulative paid claims and allocated claim adjustment expenses, net of reinsurance	73,932		153,236		1,291		228,459
Net medical claims payable, end of year	3,281		7,613		195		11,089
Ceded medical claims payable, end of year	13		33		—		46
Insurance lines other than short duration	—		224		—		224
Gross medical claims payable, end of year	$	3,294	$	7,870	$	195	$	11,359