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, 2022 is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Gross medical claims payable, beginning of year	$	3,847	$	9,157	$	278	$	13,282
Ceded medical claims payable, beginning of year	(13)		(8)		—		(21)
Net medical claims payable, beginning of year	3,834		9,149		278		13,261
Business combinations and purchase adjustments	3		130		—		133
Net incurred medical claims:
Current year	30,067		81,795		1,552		113,414
Prior years redundancies	(154)		(630)		(85)		(869)
Total net incurred medical claims	29,913		81,165		1,467		112,545
Net payments attributable to:
Current year medical claims	26,274		71,463		1,260		98,997
Prior years medical claims	3,362		8,052		186		11,600
Total net payments	29,636		79,515		1,446		110,597
Net medical claims payable, end of year	4,114		10,929		299		15,342
Ceded medical claims payable, end of year	5		1		—		6
Gross medical claims payable, end of year	$	4,119	$	10,930	$	299	$	15,348


	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


	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

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 $869 shown above for the year ended December 31, 2022 represents an estimate based on paid claim activity from January 1, 2022 to December 31, 2022. 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 $869 redundancy relates to claims incurred in calendar year 2021.

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, 2022, 2021 and 2020, 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. We had increased estimation uncertainty on our incurred but not reported liability at December 31, 2022 and December 31, 2021. Slowdowns in claims submission patterns and increases in utilization levels for COVID-19 testing and treatment are the primary factors that lead to the increased estimation uncertainty.


	Favorable Developments by Changes in Key Assumptions
	2022		2021		2020
Assumed trend factors	$	(859)	$	(1,429)	$	(599)
Assumed completion factors	(10)		(274)		(38)
Total	$	(869)	$	(1,703)	$	(637)

The favorable development recognized in 2022 resulted primarily from trend factors in late 2021 developing more favorably than originally expected as well as a smaller contribution from completion factor development.

The favorable development recognized in 2021 resulted primarily from trend factors in late 2020 developing more favorably than originally expected as well as a smaller but significant contribution from completion factor development.

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.


	Years Ended December 31
	2022		2021		2020
Net incurred medical claims:
Commercial & Specialty Business	$	29,913	$	27,667	$	24,519
Government Business	81,165		69,448		58,650
Other	1,467		1,622		1,288
Total net incurred medical claims	112,545		98,737		84,457
Quality improvement and other claims expense	3,942		3,908		3,588
Benefit expense	$	116,487	$	102,645	$	88,045


Commercial & Specialty Business	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2020		2021
Claim Years	(Unaudited)		(Unaudited)		2022
2020 & Prior	$	27,545	$	27,080	$	27,101
2021			28,132		27,957
2022					30,070
Total					$	85,128


Commercial & Specialty Business	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2020		2021
Claim Years	(Unaudited)		(Unaudited)		2022
2020 & Prior	$	24,263	$	26,876	$	27,049
2021			24,502		27,691
2022					26,274
Total					$	81,014

At December 31, 2022, the total of incurred but not reported liabilities plus expected development on reported claims for the Commercial & Specialty Business was $52, $266 and $3,796 for the claim years 2020 and prior, 2021 and 2022, respectively.

At December 31, 2022, the cumulative number of reported claims for the Commercial & Specialty Business was 80, 87 and 81 for the claim years 2020 and prior, 2021 and 2022, respectively.


Government Business	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2020		2021
Claim Years	(Unaudited)		(Unaudited)		2022
2020 & Prior	$	64,379	$	63,158	$	63,123
2021			71,045		70,450
2022					81,925
Total					$	215,498


Government Business	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2020		2021
Claim Years	(Unaudited)		(Unaudited)		2022
2020 & Prior	$	56,767	$	62,821	$	62,981
2021			62,233		70,125
2022					71,463
Total					$	204,569

At December 31, 2022, the total of incurred but not reported liabilities plus expected development on reported claims for the Government Business was $142, $325 and $10,462 for the claim years 2020 and prior, 2021 and 2022, respectively.


Other	Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2020		2021
Claim Years	(Unaudited)		(Unaudited)		2022
2020 & Prior	$	1,486	$	1,470	$	1,459
2021			1,683		1,609
2022					1,552
Total					$	4,620


Other	Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
	2020		2021
Claim Years	(Unaudited)		(Unaudited)		2022
2020 & Prior	$	1,292	$	1,454	$	1,458
2021			1,421		1,603
2022					1,260
Total					$	4,321

At December 31, 2022, the total of incurred but not reported liabilities plus expected development on reported claims for Other was $1, $6 and $292 for the claim years 2020 and prior, 2021 and 2022, respectively.

The information about incurred claims development, paid claims development and cumulative number of reported claims for the years ended December 31, 2020 and 2021 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, 2022, reflected in the tables above, to the consolidated ending balance for medical claims payable included in the consolidated balance sheet, as of December 31, 2022, is as follows:


	Commercial & Specialty Business		Government Business		Other		Total
Cumulative incurred claims and allocated claim adjustment expenses, net of reinsurance	$	85,128	$	215,498	$	4,620	$	305,246
Less: Cumulative paid claims and allocated claim adjustment expenses, net of reinsurance	81,014		204,569		4,321		289,904
Net medical claims payable, end of year	4,114		10,929		299		15,342
Ceded medical claims payable, end of year	5		1		—		6
Insurance lines other than short duration	—		248		—		248
Gross medical claims payable, end of year	$	4,119	$	11,178	$	299	$	15,596