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Significant Accounting Policies (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2018
USD ($)
item
Dec. 31, 2017
USD ($)
Sep. 30, 2019
USD ($)
Jan. 01, 2018
USD ($)
Premiums Receivable        
Allowance for doubtful accounts $ 0 $ 0    
Property and Equipment        
Number of state licenses acquired | item 7      
Allocated amount of acquired state licenses $ 700      
Impairments of intangible assets 0 0    
Impairments of long lived assets 0 0    
Retained earnings 28,355 6,921 $ 22,977 $ 3,200
Accumulated other comprehensive (loss) income (563) 2,993 $ 5,896 $ 3,200
Prepaid Expenses and Other Current Assets        
Deferred offering costs $ 1,100 $ 0    
Minimum        
Property and Equipment        
Useful life 3 years      
Maximum        
Property and Equipment        
Useful life 5 years