Unpaid Claims - Incurred Claims (Details) $ in Thousands	Dec. 31, 2022 USD ($) claim	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Claims Development [Line Items]
Cumulative incurred claims	$ 3,369,971	$ 2,385,940	$ 1,547,806
Total IBNR	$ 137,395
Number of reported claims | claim	6,754,769,000
Unpaid claims	$ 137,395	136,317	103,976
Non-Insurance
Claims Development [Line Items]
Unpaid claims	6,100	4,600
2020 and prior
Claims Development [Line Items]
Cumulative incurred claims	1,559,073	1,563,639	1,547,806
Total IBNR	$ 1,010
Number of reported claims | claim	1,433,039,000
2021
Claims Development [Line Items]
Cumulative incurred claims	$ 787,543	822,300	0
Total IBNR	$ 3,524
Number of reported claims | claim	2,384,691,000
2022
Claims Development [Line Items]
Cumulative incurred claims	$ 1,023,355	$ 0	$ 0
Total IBNR	$ 132,861
Number of reported claims | claim	2,937,039,000