Liability for Unpaid Claims - Schedule of Liability for Unpaid Health Claims (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Activity in the Liability for Unpaid Health Claims
Beginning balance less reinsurance recoverable	$ 509,356		$ 402,693
Paid related to:
Beginning balance plus reinsurance recoverable	514,875	$ 509,356
Health claims
Activity in the Liability for Unpaid Health Claims
Beginning balance	182,202	171,109	165,458
Plus reinsurance recoverables, beginning balance	2,084	2,628	3,124
Beginning balance less reinsurance recoverable	184,286	173,737	168,582
Incurred related to:
Current year	697,521	676,189	638,134
Prior years	(4,853)	(15,631)	(22,477)
Total incurred	692,668	660,558	615,657
Paid related to:
Current year	535,971	517,855	487,096
Prior years	146,247	131,610	122,910
Total paid	682,218	649,465	610,006
Ending balance	192,652	182,202	171,109
Plus reinsurance recoverables, ending balance	2,157	2,084	2,628
Beginning balance plus reinsurance recoverable	$ 194,809	$ 184,286	$ 173,737