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Equity method investment Equity method investment - Financial Position and Results of Operations (Details) - Bankers Healthcare Group, LLC - USD ($)
12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Schedule of Equity Method Investments [Line Items]      
Assets $ 459,816,000 $ 330,030,000  
Liabilities 324,211,000 224,837,000  
Equity interests 135,605,000 105,193,000  
Total liabilities and equity interests 459,816,000 330,030,000  
Equity Method Investment, Summarized Financial Information, Income Statement [Abstract]      
Revenues 220,253,000 160,209,000 $ 136,693,000
Net income, pre tax $ 104,297,000 $ 77,941,000 $ 67,135,000