Reputation grade
A
Peer-relative, A–F
Insurer profile · NAIC + CMS
Avera Health Plans, Inc.
Avera Health Plans, Inc.'s complaint record, claim-denial rate and reputation grade, drawn from published NAIC complaint data and CMS Transparency in Coverage.
- A
- Reputation grade
- 2.4%
- Claims denied
- 1
- States (CMS data)
The verdict
Avera Health Plans, Inc. earns a A reputation grade - far fewer consumer problems than peers of its size, according to CMS Transparency in Coverage filings, 2.4% of its marketplace claims were denied across 1 state.
- A
- reputation grade
- 2.4%
- claims denied (CMS)
Grades are peer-relative within PlainInsurer's dataset. A high complaint ratio is not proof of wrongdoing, larger insurers draw more complaints by volume, which the index normalises.
NAIC complaint index
N/A
1.0 = market average; lower is better
Claim denial rate
2.4%
CMS, 1 states
Reputation grade A (composite score 98.3) - A=Excellent, F=Failing. Based on NAIC complaint ratios and CMS denial data.
Other A-graded carriers in PlainInsurer's dataset include Lincoln National Life and Principal Financial, and the closest overall composite score to Avera Health Plans, Inc.'s 98.3 belongs to PacificSource Health Plans (97.7).
Other A-graded insurers
Carriers with the same peer-relative reputation grade
| Insurer | Grade |
|---|---|
| Lincoln National Life | A |
| Principal Financial | A |
| TIAA Life | A |
| Mutual of Omaha | A |
| USAA Homeowners | A |
Closest composite score to Avera Health Plans, Inc.
Carriers with the nearest overall composite score (98.3)
| Insurer | Composite score |
|---|---|
| PacificSource Health Plans | 97.7 |
| Imperial Insurance Companies, Inc. | 98.9 |
| Sanford Health Plan | 96.6 |
| HealthPartners Insurance Company | 95.5 |
| Kaiser Foundation Health Plan, Inc. | 94.9 |
CMS marketplace filing
Reported appeal outcomes for Avera Health Plans, Inc.
223
appeals filed
122
overturned (reported outcomes)
54.7%
of appeals with a reported outcome
The reported appeals on this profile come from South Dakota (223 filed, 122 overturned).
CMS reports an overturn outcome for 223 of these 223 filed appeals; missing outcomes are excluded from the percentage. These filing totals are not a prediction for an individual appeal. View the CMS source ↗
What the data shows for Avera Health Plans, Inc.
Avera Health Plans, Inc. carries a A reputation grade in PlainInsurer's dataset, with a composite score of 98.3 (higher means more consumer friction relative to size). It does not yet carry enough NAIC complaint history for a normalized complaint index.
On the claims side, CMS Transparency-in-Coverage filings show Avera Health Plans, Inc. denied 2.4% of marketplace claims across 1 reporting state - a moderate rate that still varies by plan design and network.
In short: complaint and denial data show how Avera Health Plans, Inc. compares to peers, not what your own claim experience will be. Weigh price, coverage terms and state licensing before any purchase. Source: NAIC Consumer Information Source complaint data (2024). Source: CMS Transparency in Coverage PUF (PY2025), cms.gov.
Use this data wisely. Complaint and denial figures reflect regulatory filings, not individual claim outcomes. A high complaint ratio is not proof of illegal behaviour. This page is informational and is not financial, legal, or insurance advice, verify coverage decisions with your insurer or a licensed agent.
What to do with this
How to act on Avera Health Plans, Inc.'s complaint and denial record.
- Compare this carrier side-by-side with another before you buy. Compare insurers
- See how every insurer in your state ranks on complaints and denials. Browse by state
- Denied a claim? Learn the internal and external appeal process. Appeal a denial
Complaint ratios normalise by premium volume so larger carriers are not penalised for writing more policies.
Frequently asked questions
What does Avera Health Plans, Inc.'s grade mean?
Avera Health Plans, Inc. received a grade of A, indicating far fewer consumer problems than peers of its size. PlainInsurer grades insurers on a curve relative to the ~200 carriers in our dataset, using the NAIC complaint index (normalized by premium volume), CMS claim denial rates, and Medicare Advantage prior-authorization data where available.
How many complaints does Avera Health Plans, Inc. have?
NAIC's public bulk data does not include a complaint-volume estimate for Avera Health Plans, Inc. - the carrier may be new, small, or file under a parent company. Absence of an estimate is missing data, not evidence of zero complaints.
How do I file a complaint against Avera Health Plans, Inc.?
Contact your state's Department of Insurance, most accept complaints online, by phone, or by mail. The NAIC also runs a central portal at naic.org. Document your policy number, claim number, dates, and the issue before filing.
Is Avera Health Plans, Inc. a good insurance company?
It depends on your coverage needs, state, and budget. PlainInsurer's A grade reflects far fewer consumer problems than peers of its size relative to peers. Always compare quotes from multiple carriers and check complaint data for your specific state and line of coverage.
What types of insurance does Avera Health Plans, Inc. offer?
Detailed line-of-business data isn't currently available for Avera Health Plans, Inc.. The carrier is licensed in 0 states.
Source: NAIC published complaint index + CMS Transparency in Coverage PY2025 Complaint index, reputation grade and per-state claim denial rates for Avera Health Plans, Inc. · 2024 NAIC complaint index aggregates state-DOI consumer complaints, normalized against premium volume (1.0 = market average). Denial rates from CMS Transparency in Coverage PY2025. Reputation grade is PlainInsurer's peer-relative methodology applied to this public data.
Download the data behind this page
The full PlainInsurer extract, covering every insurer including Avera Health Plans, Inc., is available as CSV and JSON. Underlying federal data is public domain; see our methodology for the compilation and grading method.
Data: NAIC published complaint index (2024) · CMS Transparency in Coverage PUF PY2025. Not affiliated with NAIC or CMS.
Every figure on PlainInsurer comes directly from NAIC MCAS and CMS Transparency in Coverage data; no editor types in numbers. See our editorial standards or methodology, or report an error. Data current as of 2026-07-28. Grades measure only the published complaint/denial data; we don't recommend any insurer or policy.