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Allowance for Expected Credit Losses - Premiums receivable (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2021
Sep. 30, 2020
Sep. 30, 2021
Sep. 30, 2020
Credit Loss [Abstract]        
Balance at beginning of period $ 2,866,578 $ 2,203,753 $ 2,064,586 $ 1,778,717
Balance at end of period 2,807,720 2,225,311 2,807,720 2,225,311
Allowance for Expected Credit Losses        
Balance at beginning of period 35,979 36,054 37,781 21,003
Cumulative effect of accounting change [1]       6,539
Change for provision of expected credit losses [2] 2,736 1,046 934 9,558
Balance at end of period 38,715 37,100 38,715 37,100
Write-offs charged against the allowance $ 1,200 $ 0 $ 2,400 $ 2,300
Accounting Standards Update     Accounting Standards Update 2016-13 [Member]  
[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 third quarter and 2020 third quarter, amounts written off were $1.2 million and nil, respectively. For the nine months ended September 30, 2021 and 2020 period, amounts written off were were $2.4 million and $2.3 million, respectively.