Reputation grade
A
Peer-relative, A–F
Insurer profile · UPMC · NAIC + CMS
UPMC Health Plan
UPMC 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
- 0.71
- Complaint index
- 1
- States active
The verdict
UPMC Health Plan earns a A reputation grade — far fewer consumer problems than peers of its size, its NAIC complaint index runs 0.71, below the 1.0 market average.
- A
- reputation grade
- 0.71
- NAIC complaint index
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 data Grade A 1 states NAIC #40401
NAIC complaint index
0.71
1.0 = market average; lower is better
Confirmed complaints
312
across 1 states
Reputation grade A (composite score 77.6) — A=Excellent, F=Failing. Based on NAIC complaint ratios and CMS denial data.
Where UPMC Health Plan sits on complaints
NAIC complaint index vs the market average and the dataset range (1.0 = market average; lower is better)
- Best in data 0.23
Lowest complaint index in PlainInsurer's dataset: 0.23
0.23 complaint index
- Market avg 1
Market average complaint index = 1.0 (NAIC benchmark)
1 complaint index
- UPMC Health Plan 0.71
UPMC Health Plan: complaint index 0.71
0.71 complaint index
- Worst in data
Highest complaint index in PlainInsurer's dataset: 3.87
3.87 complaint index
What this shows UPMC Health Plan's complaint index of 0.71 is 29% below the 1.0 market average for a carrier of its size.
Complaint record by line of business
| Line | Confirmed complaints | Complaint index | States active |
|---|---|---|---|
| Health Insurance (Individual) | 312 | 0.71 | 1 |
What the data shows for UPMC Health Plan
UPMC Health Plan, part of UPMC, carries a A reputation grade in PlainInsurer's dataset, with a composite score of 77.6 (higher means more consumer friction relative to size). Its NAIC complaint index of 0.71 sits below the 1.0 market average, meaning policyholders escalate fewer disputes to regulators than is typical for a carrier of its premium volume.
UPMC Health Plan does not appear in the CMS marketplace claim-denial file, which covers individual-market health issuers — common for auto, home and life carriers. The carrier reports activity across 1 line of business.
The practical implication: complaint and denial data give a comparative view of how UPMC Health Plan treats policyholders relative to peers, but they cannot predict your individual claim experience. Compare the grade against named alternatives in your state, and weigh price, coverage terms and state licensing before any purchase. Source: NAIC Consumer Information Source complaint data (2024).Reputation grade computed by PlainInsurer from public NAIC data — see methodology.
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.
Frequently asked questions
What does UPMC Health Plan's grade mean?
UPMC Health Plan 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) and Medicare Advantage prior-authorization data where available.
How many complaints does UPMC Health Plan have?
UPMC Health Plan has 312 confirmed complaints on record across 1 state, based on published NAIC complaint data. Raw counts favour smaller insurers — PlainInsurer uses the complaint index (complaints relative to premium volume, where 1.0 is the market average) to compare carriers fairly.
How do I file a complaint against UPMC Health Plan?
Contact your state's Department of Insurance — every state has an insurance commissioner's office that accepts consumer complaints online, by phone, or by mail. The NAIC also runs a central complaint portal at naic.org. Document your policy number, claim number, dates, and the specific issue before filing.
Is UPMC Health Plan 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 UPMC Health Plan offer?
Based on NAIC filing data, UPMC Health Plan reports activity in 1 line of business: Health Insurance (Individual). Availability varies by state.
What to do with this
How to act on UPMC Health Plan'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
- Understand how the complaint index compares carriers fairly. Read the guide
Complaint ratios normalise by premium volume so larger carriers are not penalised for writing more policies.
Source: NAIC published complaint index data Complaint index, reputation grade for UPMC Health Plan · 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.
Data: NAIC published complaint index (2024). Not affiliated with NAIC or CMS. Read our methodology.