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Allowance for Expected Credit Losses - Premiums receivable (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2021
Jun. 30, 2020
Jun. 30, 2021
Jun. 30, 2020
Credit Loss [Abstract]        
Balance at beginning of period $ 2,618,175 $ 2,155,204 $ 2,064,586 $ 1,778,717
Balance at end of period 2,866,578 2,203,753 2,866,578 2,203,753
Allowance for Expected Credit Losses        
Balance at beginning of period 36,111 27,990 37,781 21,003
Cumulative effect of accounting change (1) [1]       6,539
Change for provision of expected credit losses (1) [2] (132) 8,064 (1,802) 8,512
Balance at end of period 35,979 36,054 35,979 36,054
Write-offs charged against the allowance $ 1,100 $ 1,800 $ 1,200 $ 2,300
Accounting Standards Update     us-gaap:AccountingStandardsUpdate201613Member  
[1] Adoption of ASU 2016-13, “Financial Instruments - Credit Losses (Topic 326)”
[2] Amounts deemed uncollectible are written-off in operating expenses. For the 2021 second quarter and 2020 second quarter, amounts written off were $1.1 million and $1.8 million, respectively. For the six months ended June 30, 2021 and 2020 period, amounts written off were were $1.2 million and $2.3 million, respectively.