Frequently Asked Questions
What is an NAIC complaint ratio?
The NAIC (National Association of Insurance Commissioners) complaint ratio compares the number of justified complaints received by an insurer to its market share. A complaint ratio of 1.0 is exactly average; above 1.0 means more complaints than expected for the insurer's size; below 1.0 means fewer. A ratio of 3.0 means 3 times the average number of complaints per market share unit.
How many insurers does PlainInsurer grade?
PlainInsurer grades 229+ insurance companies using NAIC MCAS 2024 data. Health insurers that disclose CMS Transparency in Coverage data receive a composite grade that also incorporates claim denial rates.
What is a claim denial rate?
The claim denial rate is the percentage of submitted insurance claims that the insurer denied. Under the ACA Transparency in Coverage rule, health insurers must publicly report their claim denial rates annually. PlainInsurer uses CMS Transparency in Coverage PUF PY2025 data, which covers 158 health insurance issuers.
Does a lower grade mean an insurer is illegal or financially insolvent?
No. Grades reflect complaint ratios and denial rates relative to industry peers — they are not assessments of financial strength or regulatory compliance. An insurer with a low grade has more complaints or higher denial rates than average, which warrants attention, but does not indicate insolvency or illegal behavior.
How is the A–F grade calculated?
Grades are computed from a composite score weighted across complaint ratio (primary), claim denial rate (for health plans), and prior authorization denial rate (for Medicare Advantage plans). The composite score is mapped to letter grades using a bell-curve distribution relative to all graded insurers — so grades reflect how an insurer compares to the full population.
Should I avoid all insurers with a C or D grade?
Not necessarily. Complaint ratios can be affected by insurer size, the types of claims they handle, and the regions they serve. An insurer with a C or D grade warrants additional scrutiny — check your state insurance commissioner's website for details on the specific complaints and review your own coverage needs carefully. Price and coverage quality also matter.
Is PlainInsurer affiliated with NAIC or CMS?
No. PlainInsurer is not affiliated with the National Association of Insurance Commissioners, CMS, or any government agency. We are an independent data portal presenting publicly available regulatory data in a more accessible format.