Liability for Unpaid Claims - Summary of Liability for Unpaid Health Claims (Details) - Health claims - USD ($) $ in Thousands	12 Months Ended
Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Activity in the Liability for Unpaid Health Claims
Beginning balance	$ 162,261	$ 163,808	$ 154,528
Incurred related to:
Current year	638,054	584,936	612,305
Prior years	(22,477)	(14,829)	(1,188)
Total incurred	615,577	570,107	611,117
Paid related to:
Current year	487,096	442,127	470,426
Prior year	122,910	129,527	131,411
Total paid	610,006	571,654	601,837
Ending balance	$ 167,832	$ 162,261	$ 163,808

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Amount, after effects of reinsurance, of payments to settle claims incurred in the current period and related claims settlement costs.

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Amount, after effects of reinsurance, of payments to settle claims incurred in prior periods and related claims settlement costs.

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Amount, after effects of reinsurance, of expense (reversal of expense) for claims incurred and costs incurred in the claim settlement process.

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Liability as of the balance sheet date for amounts representing estimated cost of settling unpaid claims under the terms of the underlying insurance policies, less estimated reinsurance recoveries on such claims. This includes an estimate for claims which have been incurred but not reported. Claim adjustment expenses represent the costs estimated to be incurred in the settlement of unpaid claims.

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A roll forward is a reconciliation of a concept from the beginning of a period to the end of a period.

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Amount, after effects of reinsurance, of payments to settle insured claims and pay costs incurred in the claims settlement process.

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Amount, after effects of reinsurance, of expense for claims incurred in the current reporting period and related claims settlement costs.

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