Plain English Breakdown
The official status indicates the bill passed both chambers but was re-referred on June 2, 2025; therefore, it may not yet be law or effective.
AI Use in Health Insurance Act
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 This Bill 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 Names or 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.
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.
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.