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Equity method investment - Financial Position and Results of Operations (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Schedule of Equity Method Investments [Line Items]
Assets	$ 36,523,936		$ 36,523,936		$ 34,932,860
Liabilities	31,332,138		31,332,138		30,028,249
Total liabilities and shareholders' equity	36,523,936		36,523,936		34,932,860
Bankers Healthcare Group, LLC
Schedule of Equity Method Investments [Line Items]
Assets	2,443,304		2,443,304		1,330,317
Liabilities	2,110,765		2,110,765		1,088,135
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest	332,539		332,539		242,182
Total liabilities and shareholders' equity	2,443,304		2,443,304		$ 1,330,317
Revenues	192,160	$ 128,510	528,767	$ 319,244
Income (Loss) from Continuing Operations, Net of Tax, Including Portion Attributable to Noncontrolling Interest	$ 63,280	$ 51,459	$ 184,195	$ 121,604

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