NEW YORK (AP) — Anthem is buying rival Cigna in a deal valued at $54.2 billion that will create the nation’s largest health insurer by enrollment, covering about 53 million patients in the U.S.

The deal comes just three weeks after the insurer Aetna bid $35 billion for Humana in a buyout frenzy that will transform five massive U.S. health companies into three even larger ones.

Shareholders of Cigna, based in Bloomfield, Connecticut, will receive $103.40 per share in cash and 0.5152 shares of Anthem stock for each of their shares. The companies put the total value at $188 per share. The deal is targeted to close in the second half of 2016.

Anthem, based in Indianapolis is the parent company of Amerigroup, one of three private managed care companies that administers KanCare, Kansas’ privatized version of Medicaid, as well as Unicare, a former CHIP contractor.