Illinois2026Active
HB0035
AI Use in Health Insurance Act
Last scannedAug 24, 2026, 10:00 AM
In one sentence
This law gives the Department of Insurance authority to oversee how health insurance companies use AI and requires a human with override power to review any negative decisions made by these systems.
What it does
- Gives the Department of Insurance oversight over how AI systems or predictive models are used to make or support adverse consumer outcomes in health insurance coverage.
- Allows the Department to investigate the development, implementation, and use of AI systems during market conduct actions.
- Prohibits insurers from issuing negative decisions about denying, reducing, or terminating benefits based solely on an AI system or predictive model.
- Requires that any decision involving AI for negative outcomes be meaningfully reviewed by a person who has the authority to override the AI's determination.
- Mandates that when a negative outcome is regulated under the Managed Care Reform and Patient Rights Act, the reviewer must be a clinical peer.
Who it affects
- Health insurance issuers in Illinois, including companies offering accident and health insurance, dental service plan corporations, health maintenance organizations, limited health service organizations, and health services plan corporations.
- The Department of Insurance, which gains new powers to investigate AI use.
Limits and unknowns
- Specific rules for how human reviews must be conducted will be created later by the Department through rulemaking.
- The provided text does not state when this law officially takes effect or if it has been signed into law, as the last action listed was a re-referral to committee.
Plain language
Terms to know
- AI system
- A machine-based tool that can generate outputs like predictions or recommendations to influence decisions in real or virtual environments.
- Adverse consumer outcome
- A decision by an insurer that negatively impacts a customer, such as violating regulatory standards or denying a claim using AI.
- Predictive model
- The use of past data and algorithms to find patterns and predict results for making decisions.
Official record
Sources
Official summary
AI USE IN HEALTH INSURANCE ACT