Goodwill and Intangible Assets Disclosure [Text Block] (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Goodwill	$ 60,205		$ 60,205		$ 50,697
Intangible Assets, Net (Excluding Goodwill)	13,687		13,687		$ 13,163
Amortization of Intangible Assets	308	$ 381	976	$ 1,124
Series of Individually Immaterial Business Acquisitions
Goodwill, Acquired During Period			$ 9,508
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life			17 years
Specialty Health Segment Member
Goodwill, Acquired During Period			$ 9,508
Finite-lived Intangible Assets Acquired			1,500
Amortization of Intangible Assets	$ 308	$ 381	$ 976	$ 1,124

Weighted average amortization period of finite-lived intangible assets acquired either individually or as part of a group of assets, in 'PnYnMnDTnHnMnS' format, for example, 'P1Y5M13D' represents the reported fact of one year, five months, and thirteen days.

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Amount of increase in assets, excluding financial assets, lacking physical substance with a definite life, from an acquisition.

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Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Sum of the carrying amounts of all intangible assets, excluding goodwill, as of the balance sheet date, net of accumulated amortization and impairment charges.

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