Annual report pursuant to Section 13 and 15(d)

Quarterly Selected Financial Information (Details)

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Quarterly Selected Financial Information (Details) (USD $)
In Thousands, except Share data, unless otherwise specified
3 Months Ended 12 Months Ended
Dec. 31, 2013
Sep. 30, 2013
Jun. 30, 2013
Mar. 31, 2013
Dec. 31, 2012
Sep. 30, 2012
Jun. 30, 2012
Mar. 31, 2012
Dec. 31, 2013
Dec. 31, 2012
Dec. 31, 2011
Quarterly Selected Financial Information [Abstract]                      
Total revenues $ 2,931,740 $ 2,795,569 $ 2,610,538 $ 2,525,482 $ 2,272,050 $ 2,308,075 $ 1,967,362 $ 1,562,809 $ 10,863,329 $ 8,110,296 $ 5,211,477
Discontinued operations, net of income tax expense (benefit) 5,275 (952) (805) 363 (9,618) (55,619) (18,343) (3,094) 3,881 (86,674) (9,300)
Net Income (Loss) Attributable to Parent 53,240 49,373 39,484 23,002 9,061 3,819 (34,999) 23,978 165,099 1,859 111,218
Continuing operations $ 0.87 $ 0.92 $ 0.74 $ 0.43 $ 0.36 $ 1.15 $ (0.32) $ 0.53 $ 2.98 $ 1.72 $ 2.40
Discontinued operations $ 0.10 $ (0.02) $ (0.02) $ 0.01 $ (0.19) $ (1.08) $ (0.36) $ (0.06) $ 0.07 $ (1.68) $ (0.18)
Income (Loss) from Continuing Operations Attributable to Parent $ 47,965 $ 50,325 $ 40,289 $ 22,639 $ 18,679 $ 59,438 $ (16,656) $ 27,072 $ 161,218 $ 88,533 $ 120,518
Earnings per common share, Basic $ 0.97 $ 0.90 $ 0.72 $ 0.44 $ 0.17 $ 0.07 $ (0.68) $ 0.47 $ 3.05 $ 0.04 $ 2.22
General and Administrative Expense Ratio 8.90% 9.10% 8.90% 8.40% 8.40% 8.40% 8.50% 10.40%      
Continuing operations $ 0.84 $ 0.88 $ 0.71 $ 0.41 $ 0.35 $ 1.10 $ (0.32) $ 0.51 $ 2.87 $ 1.65 $ 2.30
Discontinued operations $ 0.09 $ (0.01) $ 0.01 $ 0.01 $ (0.18) $ (1.03) $ (0.36) $ (0.06) $ 0.07 $ (1.62) $ (0.18)
Earnings per common share, Diluted $ 0.93 $ 0.87 $ 0.72 $ 0.42 $ 0.17 $ 0.07 $ (0.68) $ 0.45 $ 2.94 $ 0.03 $ 2.12
Period End At Risk Membership 2,723,200 2,612,500 2,563,400 2,553,400 2,424,500 2,357,600 2,254,000 2,003,800      
Health Benefit Ratio 88.10% 87.80% 88.40% 90.20% 90.70% 88.70% 91.20% 87.10%