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Medical Claims Payable
 12 Months Ended
Dec. 31, 2025
Insurance [Abstract]  
Medical Claims Payable Medical Claims Payable
A reconciliation of the beginning and ending balances for medical claims payable for the years ended December 31, 2025, 2024 and 2023 is as follows:
202520242023
Gross medical claims payable, beginning of year$15,580 $15,865 $15,348 
Ceded medical claims payable, beginning of year(13)(7)(6)
Net medical claims payable, beginning of year15,567 15,858 15,342 
Business combinations and purchase adjustments344 143 — 
Net incurred medical claims:
Current year145,566 125,370 121,798 
Prior years redundancies(1,290)(1,731)(1,571)
Total net incurred medical claims144,276 123,639 120,227 
Net payments attributable to:
Current year medical claims130,265 110,930 107,146 
Prior years medical claims13,141 13,143 12,565 
Total net payments143,406 124,073 119,711 
Net medical claims payable, end of year16,781 15,567 15,858 
Ceded medical claims payable, end of year48 13 7 
Gross medical claims payable, end of year$16,829 $15,580 $15,865 
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 run out, 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 $1,290 shown above for the year ended December 31, 2025, represents an estimate based on paid claim activity from January 1, 2025 to December 31, 2025. 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 $1,290 redundancy relates to claims incurred in calendar year 2024.
The following table provides a summary of the two key assumptions having the most significant impact on our incurred but not paid liability estimates for the years ended December 31, 2025, 2024 and 2023, which are the completion and trend factors. These vital assumptions can be affected by variables such as utilization levels, unit costs, mix of business, benefit plan designs, provider reimbursement levels, processing system conversions and changes, claim inventory levels, claim processing and submission patterns, and operational changes resulting from business combinations.
 Favorable Developments
by Changes in Key Assumptions
 202520242023
Assumed trend factors$(1,000)$(688)$(895)
Assumed completion factors(290)(1,043)(676)
Total$(1,290)$(1,731)$(1,571)
The favorable development recognized in 2025 resulted primarily from trend factors in late 2024 developing more favorably than originally expected as well as a smaller but significant contribution from completion factor development.
The favorable development recognized in 2024 resulted primarily from completion factors developing more favorably than originally expected as well as a smaller but significant contribution from trend factors in late 2023.
The favorable development recognized in 2023 resulted primarily from trend factors in late 2022 developing more favorably than originally expected. Favorable development in the completion factors in late 2022 also contributed to the favorable development in 2023.
The reconciliation of net incurred medical claims to benefit expense included in the consolidated statements of income is as follows:
Years Ended December 31
202520242023
Net incurred medical claims with medical claims payable
$140,560 $123,639 $120,227 
Performance-based risk arrangements without medical claims payable
3,716 — — 
Total net incurred medical claims144,276 123,639 120,227 
Quality improvement and other claims expense3,947 3,928 4,103 
Benefit expense$148,223 $127,567 $124,330 
Incurred claims development, net of reinsurance, for the years ended December 31, 2025, 2024 and 2023 is as follows:
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
202320242025
Claim Years(Unaudited)(Unaudited)
2023 & Prior$135,569 $133,837 $133,879 
2024125,513 124,181 
2025145,910 
Total$403,970 
Paid claims development, net of reinsurance, for the years ended December 31, 2025, 2024 and 2023 is as follows:
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
202320242025
Claim Years(Unaudited)(Unaudited)
2023 & Prior$119,711 $132,853 $133,572 
2024110,930 123,352 
2025130,265 
Total$387,189 
At December 31, 2025, the total of incurred but not reported liabilities plus expected development on reported claims was $307, $829 and $15,645 for the claim years 2023 and prior, 2024 and 2025, respectively.
At December 31, 2025, the cumulative number of reported claims was 538, 522 and 474 for the claim years 2023 and prior, 2024 and 2025, respectively.
The information about incurred claims development, paid claims development and cumulative number of reported claims for the years ended December 31, 2023 and 2024 is unaudited and presented as supplementary information.
The cumulative number of reported claims for each claim year has 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 incurred and paid claims development information for the three years ended December 31, 2025, reflected in the tables above, to the consolidated ending balance for medical claims payable included in the consolidated balance sheets, as of December 31, 2025, is as follows:
Total
Cumulative incurred claims and allocated claim adjustment expenses, net of reinsurance$403,970 
Less: Cumulative paid claims and allocated claim adjustment expenses, net of reinsurance387,189 
Net medical claims payable, end of year16,781 
Ceded medical claims payable, end of year48 
Insurance lines other than short duration255 
Gross medical claims payable, end of year$17,084