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Allowance for Expected Credit Losses - Premiums receivable (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Credit Loss [Abstract]    
Balance at beginning of period $ 2,064,586 $ 1,778,717
Balance at end of period 2,633,280 2,064,586
Allowance for Expected Credit Losses    
Balance at beginning of period 37,781 21,003
Cumulative effect of accounting change [1]   6,539
Change for provision of expected credit losses [2] 2,177 10,239
Balance at end of period 39,958 37,781
Write-offs charged against the allowance $ 3,800 $ 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 2021 and 2020 periods, amounts written off totaled $3.8 million and $2.8 million, respectively