Reputation grade
A
Peer-relative, A–F
Insurer profile · NAIC + CMS
Capital Health Plan
Capital Health Plan's complaint record, claim-denial rate and reputation grade, drawn from published NAIC complaint data and CMS Transparency in Coverage.
- A
- Reputation grade
- 7.1%
- Claims denied
- 1
- States (CMS data)
The verdict
Capital Health Plan earns a A reputation grade - far fewer consumer problems than peers of its size, according to CMS Transparency in Coverage filings, 7.1% of its marketplace claims were denied across 1 state.
- A
- reputation grade
- 7.1%
- claims denied (CMS)
NAIC complaint index
N/A
1.0 = market average; lower is better
Claim denial rate
7.1%
CMS, 1 states
Graded on 2 of 3 measures: claim denials, prior authorisation. 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 →Other A-graded carriers in PlainInsurer's dataset include Lincoln National Life and Principal Financial, and the closest overall composite score to Capital Health Plan's 92.6 belongs to Group Health Cooperative of South Central Wisconsin (92.3), each rescaled across the measures that carrier reports.
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 Capital Health Plan
Carriers with the nearest overall composite score (92.6)
| Insurer | Composite score |
|---|---|
| Group Health Cooperative of South Central Wisconsin | 92.3 |
| Chorus Community Health Plans | 91.9 |
| Kaiser Foundation Healthplan of the NW | 93.5 |
| Healthy Alliance Life Co(Anthem BCBS) | 91.4 |
| Priority Health | 94.1 |
CMS marketplace filing
Reported appeal outcomes for Capital Health Plan
257
appeals filed
87
overturned (reported outcomes)
33.9%
of appeals with a reported outcome
The reported appeals on this profile come from Florida (257 filed, 87 overturned).
CMS reports an overturn outcome for 257 of these 257 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 Capital Health Plan
Capital Health Plan carries a A reputation grade in PlainInsurer's dataset, with a composite score of 92.6 (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 Capital Health Plan denied 7.1% of marketplace claims across 1 reporting state - a moderate rate that still varies by plan design and network.
See where Capital Health Plan sits against every reporting carrier in the claim-denial rate ranking.
Source: NAIC Consumer Information Source complaint data (2024). Source: CMS Transparency in Coverage PUF (PY2026), cms.gov.
Aggregates only, not advice. Full terms on the disclaimer.
Questions about Capital Health Plan
What does Capital Health Plan's grade mean?
Capital Health Plan received a grade of A, indicating far fewer consumer problems than peers of its size.
How many complaints does Capital Health Plan have?
NAIC's public bulk data does not include a complaint-volume estimate for Capital Health Plan - 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 Capital Health Plan?
File against Capital Health Plan through your state's Department of Insurance or the NAIC consumer portal at naic.org.
Is Capital Health Plan a good insurance company?
PlainInsurer's A grade for Capital Health Plan reflects far fewer consumer problems than peers of its size relative to peers on published complaint and denial data.
What types of insurance does Capital Health Plan offer?
Detailed line-of-business data isn't currently available for Capital Health Plan. The carrier is licensed in 0 states.
Source: NAIC published complaint index + CMS Transparency in Coverage PY2026 Complaint index, reputation grade and per-state claim denial rates for Capital Health Plan · 2024
Share, download, and related pages for Capital Health Plan
Download the data behind this page
The full PlainInsurer extract, covering every insurer including Capital Health Plan, 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.