For the seventh consecutive year, Kaiser Permanente ranked highest in customer satisfaction for health insurance among California policyholders, according to ratings firm J.D. Power & Associates.

But two other major rivals -- Blue Shield of California and Anthem Blue Cross -- scored the lowest on member satisfaction among seven California health plans.

In its annual survey, J.D. Power surveyed more than 34,000 customers of 136 commercial health plans in December and January in 18 regions across the country. The firm asked about coverage, provider choice, cost, customer service, claims processing and communication.

Nationally, the average satisfaction score was 669 out of 1,000 possible points.

The average score in California was 680, down from 706 a year ago.

No other California health insurers besides Kaiser performed above the state average.

Kaiser scored 756 among its Golden State customers, followed by Cigna (674), UnitedHealthcare (667), Aetna (655), Health Net (653), Anthem Blue Cross (650) and Blue Shield of California (639).

Kaiser, the nation's largest nonprofit health plan and hospital system, also led the way in customer satisfaction in Colorado, the Northwest region, the Mid-Atlantic states and the South Atlantic area.

Nationwide, the J.D. Power survey found that 41% of existing health plan customers don't feel they have enough coverage for routine doctor visits, serious illnesses and prescriptions.

And 55 percent of people surveyed said their health insurance costs went up last year. The average monthly premium for 2013 was $285, according to the survey.

The lack of timely information from health plans was another big concern among consumers.

"On average, members wait eight days for communication from their provider after a pre-approval request has been submitted," said Rick Johnson, senior director of the healthcare practice at J.D. Power.

"Health plans must look for ways to promptly communicate both pre-approvals and cost in order to minimize member anxiety," Johnson added.