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
- 3.5%
- 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, 3.5% of its marketplace claims were denied across 1 state.
- A
- reputation grade
- 3.5%
- claims denied (CMS)
Graded on 1 of 3 measures: claim denials. The score is rescaled across the measures available, so it is not directly comparable with a carrier graded on more of them.
How we calculated this grade →NAIC CIS filing desk
NAIC NAIC A · 99.5
GRADE-A · INDEX-UNK · DENIAL-QUIET · RANK-UNK · PHOTO-SOLO · LINES-0 · BOOK-MID
- GRADE-A A · 99.5
- INDEX-UNK Index blank
- DENIAL-QUIET 3.5% denied
- RANK-UNK Rank pending
- PHOTO-SOLO No peer gap
- LINES-0 No lines
- BOOK-MID 3/7 fields
Instrument codes from this carrier’s NAIC Consumer Information Source filing: grade band, complaint index, CMS denial band, corpus rank, photo-finish peer, line book, and field completeness. Not an official NAIC rating.
CMS marketplace filing
Reported appeal outcomes for Avera Health Plans, Inc.
The reported appeals on this profile come from South Dakota (154 filed, 69 overturned).
CMS reports an overturn outcome for 154 of these 154 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 NAIC filing desk shows for Avera Health Plans, Inc.
Avera Health Plans, Inc.'s filing desk summarizes the NAIC complaint record and any CMS marketplace denial data on file.
See where Avera Health Plans, Inc. sits against every reporting carrier in the claim-denial rate ranking. Appeal notes for Avera Health Plans.
Nationwide insurers with similar scores or complaint volume
Two corpus-wide peer sets for Avera Health Plans, Inc.: nearest national-scale carriers by composite score and by NAIC complaint volume. These are cross-market neighborhoods, not the corporate-family list or same-grade chips above.
Similar composite score
Nearest carriers by composite score (99.5 here). Floored at 50+ complaints and 5+ states.
Questions about Avera Health Plans, Inc.
What does Avera Health Plans, Inc.'s grade mean?
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How do I file a complaint against Avera Health Plans, Inc.?
Is Avera Health Plans, Inc. a good insurance company?
What types of insurance does Avera Health Plans, Inc. offer?
Source: NAIC published complaint index + CMS Transparency in Coverage PY2026 Complaint index, reputation grade and per-state claim denial rates for Avera Health Plans, Inc. · 2024
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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 PY2026. 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 2026-08-11. Grades measure only the published complaint/denial data; we don't recommend any insurer or policy.