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Equity method investment - Financial Position and Results of Operations (Details) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2021
Mar. 31, 2020
Dec. 31, 2020
Schedule of Equity Method Investments [Line Items]      
Assets $ 35,299,705   $ 34,932,860
Liabilities 30,340,181   30,028,249
Total liabilities and shareholders' equity 35,299,705   34,932,860
Bankers Healthcare Group, LLC      
Schedule of Equity Method Investments [Line Items]      
Assets 1,608,912   1,330,317
Liabilities 1,334,066   1,088,135
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest 274,846   242,182
Total liabilities and shareholders' equity 1,608,912   $ 1,330,317
Revenues 157,623 $ 97,943  
Income (Loss) from Continuing Operations, Net of Tax, Including Portion Attributable to Noncontrolling Interest $ 58,562 $ 32,471