A reconciliation of the beginning and ending balances for medical claims payable for the nine months ended September 30, 2026 and 2025 is as follows:


	2026		2025
Gross medical claims payable, beginning of period	$	16,829	$	15,580
Ceded medical claims payable, beginning of period	(48)		(13)
Net medical claims payable, beginning of period	16,781		15,567
Business combinations and purchase adjustments	—		344
Net incurred medical claims:
Current period	108,608		108,423
Prior periods redundancies	(1,295)		(1,266)
Total net incurred medical claims	107,313		107,157
Net payments attributable to:
Current period medical claims	92,416		93,545
Prior periods medical claims	13,629		12,699
Total net payments	106,045		106,244
Net medical claims payable, end of period	18,049		16,824
Ceded medical claims payable, end of period	45		44
Gross medical claims payable, end of period	$	18,094	$	16,868

At September 30, 2026, the total of net incurred but not reported liabilities plus expected development on reported claims was $16,192, $1,445 and $412 for the claim years 2026, 2025, and 2024 and prior, respectively.

The favorable development recognized in the nine months ended September 30, 2026 resulted from both favorable completion and trend factor development from 2025.

The favorable development recognized in the nine months ended September 30, 2025 resulted from trend factors in late 2024 developing more favorably than originally expected as well as a smaller contribution from faster than expected development of completion factors from the latter part of 2024.

The reconciliation of net incurred medical claims to benefit expense included in our consolidated statements of income for the nine months ended September 30, 2026 and 2025 is as follows:



	2026		2025
Net incurred medical claims with medical claims payable	$	107,094	$	103,923
Performance-based risk arrangements without medical claims payable	219		3,234
Total net incurred medical claims	107,313		107,157
Quality improvement and other claims expense	3,105		3,001
Benefit expense	$	110,418	$	110,158

Net incurred medical claims under certain performance-based risk arrangements that include gain or loss sharing components do not require a medical claim payable liability.

The reconciliation of the medical claims payable reflected in the tables above to the consolidated ending balance for medical claims payable included in the consolidated balance sheets, as of September 30, 2026 is as follows:



	Total
Net medical claims payable, end of period	$	18,049
Ceded medical claims payable, end of period	45
Insurance lines other than short duration	344
Gross medical claims payable, end of period	$	18,438