(1)–(11) As used in this act: 1. "Artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms" means any artificial system that performs tasks under varying and unpredictable circumstances without significant human oversight or that can learn from experience and improve performance when exposed to data sets;36 O.S. § 6980.2(1)" means any artificial system that performs tasks under varying and unpredictable circumstances without significant human oversight or that can learn from experience and improve performance when exposed to data sets; 2. "CommissionerCommissioner"Commissioner" means the Oklahoma Insurance Commissioner;36 O.S. § 6980.2(2)" means the Oklahoma Insurance CommissionerCommissioner"Commissioner" means the Oklahoma Insurance Commissioner;36 O.S. § 6980.2(2); 3. "Covered personCovered person"Covered person" means a policyholder, subscriber, or other individual who is entitled to receive health care services under a health insurance policy;36 O.S. § 6980.2(3)" means a policyholder, subscriber, or other individual who is entitled to receive health care servicesHealth care service"Health care service" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a covered person for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policy;36 O.S. § 6980.2(6) under a health insurance policyHealth insurance policy"Health insurance policy" means a policy, subscriber contract, certificate, or plan issued by an insurer that provides medical or health care coverage. The term does not include: a. an accident-only policy, b. a credit-only policy, c. a long-term care or disability income policy, d. a specified disease policy, e. a Medicare supplement policy, f. a TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy, g. a fixed indemnity policy, h. a hospital indemnity policy, i. a dental-only policy, j. a vision-only policy, k. a workers' compensation policy, l. an automobile medical payment policy, m. a homeowner's insurance policy, or n. any other similar policies providing for limited benefits;36 O.S. § 6980.2(7); 4. "DepartmentDepartment"Department" means the Oklahoma Insurance Department;36 O.S. § 6980.2(4)" means the Oklahoma Insurance DepartmentDepartment"Department" means the Oklahoma Insurance Department;36 O.S. § 6980.2(4); 5. "Health care providerHealth care provider"Health care provider" means a licensed hospital or health care facility, medical equipment supplier, or person who is licensed, certified, or otherwise regulated to provide health care services under the laws of Oklahoma;36 O.S. § 6980.2(5)" means a licensed hospital or health care facility, medical equipment supplier, or person who is licensed, certified, or otherwise regulated to provide health care servicesHealth care service"Health care service" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a covered person for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policy;36 O.S. § 6980.2(6) under the laws of Oklahoma; 6. "Health care serviceHealth care service"Health care service" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a covered person for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policy;36 O.S. § 6980.2(6)" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care providerHealth care provider"Health care provider" means a licensed hospital or health care facility, medical equipment supplier, or person who is licensed, certified, or otherwise regulated to provide health care services under the laws of Oklahoma;36 O.S. § 6980.2(5) to a covered personCovered person"Covered person" means a policyholder, subscriber, or other individual who is entitled to receive health care services under a health insurance policy;36 O.S. § 6980.2(3) for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policyHealth insurance policy"Health insurance policy" means a policy, subscriber contract, certificate, or plan issued by an insurer that provides medical or health care coverage. The term does not include: a. an accident-only policy, b. a credit-only policy, c. a long-term care or disability income policy, d. a specified disease policy, e. a Medicare supplement policy, f. a TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy, g. a fixed indemnity policy, h. a hospital indemnity policy, i. a dental-only policy, j. a vision-only policy, k. a workers' compensation policy, l. an automobile medical payment policy, m. a homeowner's insurance policy, or n. any other similar policies providing for limited benefits;36 O.S. § 6980.2(7); 7. "Health insurance policyHealth insurance policy"Health insurance policy" means a policy, subscriber contract, certificate, or plan issued by an insurer that provides medical or health care coverage. The term does not include: a. an accident-only policy, b. a credit-only policy, c. a long-term care or disability income policy, d. a specified disease policy, e. a Medicare supplement policy, f. a TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy, g. a fixed indemnity policy, h. a hospital indemnity policy, i. a dental-only policy, j. a vision-only policy, k. a workers' compensation policy, l. an automobile medical payment policy, m. a homeowner's insurance policy, or n. any other similar policies providing for limited benefits;36 O.S. § 6980.2(7)" means a policy, subscriber contract, certificate, or plan issued by an insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) that provides medical or health care coverage. The term does not include: a. an accident-only policy, b. a credit-only policy, c. a long-term care or disability income policy, d. a specified disease policy, e. a Medicare supplement policy, f. a TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy, g. a fixed indemnity policy, h. a hospital indemnity policy, i. a dental-only policy, j. a vision-only policy, k. a workers' compensation policy, l. an automobile medical payment policy, m. a homeowner's insurance policy, or n. any other similar policies providing for limited benefits; 8. "InsurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8)" means an entity licensed by the DepartmentDepartment"Department" means the Oklahoma Insurance Department;36 O.S. § 6980.2(4) that offers, issues, or renews an individual or group health insurance policyHealth insurance policy"Health insurance policy" means a policy, subscriber contract, certificate, or plan issued by an insurer that provides medical or health care coverage. The term does not include: a. an accident-only policy, b. a credit-only policy, c. a long-term care or disability income policy, d. a specified disease policy, e. a Medicare supplement policy, f. a TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy, g. a fixed indemnity policy, h. a hospital indemnity policy, i. a dental-only policy, j. a vision-only policy, k. a workers' compensation policy, l. an automobile medical payment policy, m. a homeowner's insurance policy, or n. any other similar policies providing for limited benefits;36 O.S. § 6980.2(7). The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan; 9. "Medical Assistance" or "CHIP Managed Care Plan" means a health care plan that uses a gatekeeper to manage the utilization of health care servicesHealth care service"Health care service" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a covered person for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policy;36 O.S. § 6980.2(6) by medical assistance or CHIP enrollees and integrates the financing and delivery of health care servicesHealth care service"Health care service" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a covered person for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policy;36 O.S. § 6980.2(6); 10. "SpecialistSpecialist"Specialist" means a health care provider whose practice is not limited to primary health care services and who has additional postgraduate or specialized training, has board certification, or practices in a licensed specialized area of health care;36 O.S. § 6980.2(10)" means a health care providerHealth care provider"Health care provider" means a licensed hospital or health care facility, medical equipment supplier, or person who is licensed, certified, or otherwise regulated to provide health care services under the laws of Oklahoma;36 O.S. § 6980.2(5) whose practice is not limited to primary health care servicesHealth care service"Health care service" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a covered person for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policy;36 O.S. § 6980.2(6) and who has additional postgraduate or specialized training, has board certification, or practices in a licensed specialized area of health care; and 11. "Utilization reviewUtilization review"Utilization review" means a set of formal techniques designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings, including prior authorization, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review, in order to make a determination regarding coverage of the service under the terms of a health insurance policy or an agreement with the Department of Human Services.36 O.S. § 6980.2(11)" means a set of formal techniques designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care servicesHealth care service"Health care service" means any covered treatment, admission, procedure, medical supplies and equipment, or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a covered person for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease under the terms of a health insurance policy;36 O.S. § 6980.2(6), procedures, or settings, including prior authorization, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review, in order to make a determination regarding coverage of the service under the terms of a health insurance policyHealth insurance policy"Health insurance policy" means a policy, subscriber contract, certificate, or plan issued by an insurer that provides medical or health care coverage. The term does not include: a. an accident-only policy, b. a credit-only policy, c. a long-term care or disability income policy, d. a specified disease policy, e. a Medicare supplement policy, f. a TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy, g. a fixed indemnity policy, h. a hospital indemnity policy, i. a dental-only policy, j. a vision-only policy, k. a workers' compensation policy, l. an automobile medical payment policy, m. a homeowner's insurance policy, or n. any other similar policies providing for limited benefits;36 O.S. § 6980.2(7) or an agreement with the Department of Human Services.

(A) 1 An insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) shall disclose to a health care providerHealth care provider"Health care provider" means a licensed hospital or health care facility, medical equipment supplier, or person who is licensed, certified, or otherwise regulated to provide health care services under the laws of Oklahoma;36 O.S. § 6980.2(5), all covered personsCovered person"Covered person" means a policyholder, subscriber, or other individual who is entitled to receive health care services under a health insurance policy;36 O.S. § 6980.2(3), and the general public if artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms" means any artificial system that performs tasks under varying and unpredictable circumstances without significant human oversight or that can learn from experience and improve performance when exposed to data sets;36 O.S. § 6980.2(1) are used, not used, or will be used in the insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8)'s utilization reviewUtilization review"Utilization review" means a set of formal techniques designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings, including prior authorization, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review, in order to make a determination regarding coverage of the service under the terms of a health insurance policy or an agreement with the Department of Human Services.36 O.S. § 6980.2(11) process. An insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) shall disclose information about the use or lack of use of artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms" means any artificial system that performs tasks under varying and unpredictable circumstances without significant human oversight or that can learn from experience and improve performance when exposed to data sets;36 O.S. § 6980.2(1) in the utilization reviewUtilization review"Utilization review" means a set of formal techniques designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings, including prior authorization, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review, in order to make a determination regarding coverage of the service under the terms of a health insurance policy or an agreement with the Department of Human Services.36 O.S. § 6980.2(11) process on the insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8)'s publicly accessible Internet website.

(B) 2 An insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) shall submit the artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms" means any artificial system that performs tasks under varying and unpredictable circumstances without significant human oversight or that can learn from experience and improve performance when exposed to data sets;36 O.S. § 6980.2(1) and training data sets that are being used or will be used in the utilization reviewUtilization review"Utilization review" means a set of formal techniques designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings, including prior authorization, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review, in order to make a determination regarding coverage of the service under the terms of a health insurance policy or an agreement with the Department of Human Services.36 O.S. § 6980.2(11) process to the DepartmentDepartment"Department" means the Oklahoma Insurance Department;36 O.S. § 6980.2(4) for transparency. The insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) shall submit an attestation to the DepartmentDepartment"Department" means the Oklahoma Insurance Department;36 O.S. § 6980.2(4), annually by December 31, in the manner and form prescribed by the DepartmentDepartment"Department" means the Oklahoma Insurance Department;36 O.S. § 6980.2(4) on its website certifying that these artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms" means any artificial system that performs tasks under varying and unpredictable circumstances without significant human oversight or that can learn from experience and improve performance when exposed to data sets;36 O.S. § 6980.2(1) and training data sets have minimized the risk of bias based on the covered personCovered person"Covered person" means a policyholder, subscriber, or other individual who is entitled to receive health care services under a health insurance policy;36 O.S. § 6980.2(3)'s race, color, religious creed, ancestry, age, sex, gender, national origin, handicap or disability, and adhere to evidence-based clinical guidelines.

3 A specialistSpecialist"Specialist" means a health care provider whose practice is not limited to primary health care services and who has additional postgraduate or specialized training, has board certification, or practices in a licensed specialized area of health care;36 O.S. § 6980.2(10) who participates in a utilization reviewUtilization review"Utilization review" means a set of formal techniques designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings, including prior authorization, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review, in order to make a determination regarding coverage of the service under the terms of a health insurance policy or an agreement with the Department of Human Services.36 O.S. § 6980.2(11) process for an insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) that initially uses artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms" means any artificial system that performs tasks under varying and unpredictable circumstances without significant human oversight or that can learn from experience and improve performance when exposed to data sets;36 O.S. § 6980.2(1) for a utilization reviewUtilization review"Utilization review" means a set of formal techniques designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings, including prior authorization, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review, in order to make a determination regarding coverage of the service under the terms of a health insurance policy or an agreement with the Department of Human Services.36 O.S. § 6980.2(11) shall open and document the utilization review of the individual clinical records or data prior to the individualized documented decision of a denial.

(A)(1)–(2) A. 1. A violation of this act shall be deemed to be an unfair method of competition and an unfair or deceptive act or practice. 2. Upon satisfactory evidence of a violation of this act by an insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) or other person, one or more of the following penalties may be imposed at the Oklahoma Insurance CommissionerCommissioner"Commissioner" means the Oklahoma Insurance Commissioner;36 O.S. § 6980.2(2)'s discretion: a. suspension or revocation of the license of the insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) or other person, b. refusal, for a period not to exceed one (1) year, to issue a new license to the insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) or other person, c. a fine of not more than Five Thousand Dollars ($5,000.00) for each violation of this act, or d. a fine of not more than Ten Thousand Dollars ($10,000.00) for each willful violation of this act.

(B)(1)–(2) B. 1. Fines imposed against an insurerInsurer"Insurer" means an entity licensed by the Department that offers, issues, or renews an individual or group health insurance policy. The term does not include an entity operating as a Medical Assistance Program or Children's Health Insurance Program (CHIP) Managed Care Plan;36 O.S. § 6980.2(8) under subsection A of this section may not exceed Five Hundred Thousand Dollars ($500,000.00) in the aggregate during a single calendar year. 2. Fines imposed against any other person under subsection A of this section may not exceed One Hundred Thousand Dollars ($100,000.00) in the aggregate during a single calendar year.

(C) C. The enforcement remedies imposed under subsection A of this section are in addition to any other remedies or penalties that may be imposed under any other applicable law of this state.

This act shall become effective November 1, 2024.