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Allowance for Expected Credit Losses - Premiums receivable (Details)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
USD ($)
Credit Loss [Abstract]  
Balance at beginning of period $ 1,778,717
Balance at end of period 2,064,586
Allowance for Expected Credit Losses  
Balance at beginning of period 21,003
Cumulative effect of accounting change 6,539 [1]
Change for provision of expected credit losses 10,239 [2]
Balance at end of period 37,781
Write-offs charged against the allowance $ 2,800
[1] Adoption of ASU 2016-13, “Financial Instruments - Credit Losses (Topic 326)”
[2] Amounts deemed uncollectible are written-off in operating expenses. For the 2020 period, amounts written off totaled $2.8 million