WHAT THIS BILL REGULATES · 1 REQUIREMENT TYPE
How Is This Bill Enforced
Verbatim statutory text on the left; plain-language analysis and a per-section checklist on the right. Numbered markers cross-link to the matching checklist row.
As used in this act:
(1) "Adverse consumer outcomeAdverse consumer outcome"Adverse consumer outcome" means a decision by a health insurance issuer that is subject to insurance regulatory standards enforced by the Insurance Department that adversely impacts the consumer in a manner that violates those standards or any claim denial;36 Okl. St. § 6568(1)" means a decision by a health insurance issuerHealth insurance issuer"Health insurance issuer" means the same as described in Section 103 of Title 36 of the Oklahoma Statutes;36 Okl. St. § 6568(5) that is subject to insurance regulatory standards enforced by the Insurance Department that adversely impacts the consumer in a manner that violates those standards or any claim denial;
(2) "AI systemAI system"AI system" means a machine-based system that can, with varying levels of autonomy, for a given set of objectives, generate outputs such as productions, recommendations, content such as text, images, videos, or sounds, or other outputs influencing decisions made in real or virtual environments. AI system includes the term artificial intelligence;36 Okl. St. § 6568(2)" means a machine-based system that can, with varying levels of autonomy, for a given set of objectives, generate outputs such as productions, recommendations, content such as text, images, videos, or sounds, or other outputs influencing decisions made in real or virtual environments. AI systemAI system"AI system" means a machine-based system that can, with varying levels of autonomy, for a given set of objectives, generate outputs such as productions, recommendations, content such as text, images, videos, or sounds, or other outputs influencing decisions made in real or virtual environments. AI system includes the term artificial intelligence;36 Okl. St. § 6568(2) includes the term artificial intelligenceArtificial intelligence"Artificial intelligence" means a computer system, program, or set of algorithms capable of performing tasks on producing outposts that imitate intelligent human behaviors;36 Okl. St. § 6568(3);
(3) "Artificial intelligenceArtificial intelligence"Artificial intelligence" means a computer system, program, or set of algorithms capable of performing tasks on producing outposts that imitate intelligent human behaviors;36 Okl. St. § 6568(3)" means a computer system, program, or set of algorithms capable of performing tasks on producing outposts that imitate intelligent human behaviors;
(4) "Health insurance coverageHealth insurance coverage"Health insurance coverage" means benefits consisting of medical care and items and services paid for as medical care, provided directly, through insurance or through reimbursement, under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer;36 Okl. St. § 6568(4)" means benefits consisting of medical care and items and services paid for as medical care, provided directly, through insurance or through reimbursement, under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuerHealth insurance issuer"Health insurance issuer" means the same as described in Section 103 of Title 36 of the Oklahoma Statutes;36 Okl. St. § 6568(5);
(5) "Health insurance issuerHealth insurance issuer"Health insurance issuer" means the same as described in Section 103 of Title 36 of the Oklahoma Statutes;36 Okl. St. § 6568(5)" means the same as described in Section 103 of Title 36 of the Oklahoma Statutes; and
(6) "Medical necessityMedical necessity"Medical necessity" means the same as defined in Section 7310 of Title 63 of the Oklahoma Statutes.36 Okl. St. § 6568(6)" means the same as defined in Section 7310 of Title 63 of the Oklahoma Statutes.
Section 6568 establishes the definitional framework for the act. It defines six terms: adverse consumer outcome (broadly covering any claim denial or any decision adversely impacting a consumer in violation of insurance regulatory standards), AI system (using language closely tracking the OECD definition), artificial intelligence, health insurance coverage, health insurance issuer (incorporating by reference the existing definition in Title 36, § 103), and medical necessity (incorporating by reference the existing definition in Title 63, § 7310).
Notably, the definition of adverse consumer outcome is broad — it encompasses not only claim denials but any decision that adversely impacts a consumer in violation of insurance regulatory standards, potentially sweeping in rate-setting, coverage modification, and benefit design decisions.
(A) 1 A licensed professional shall issue any final adverse consumer outcomeAdverse consumer outcome"Adverse consumer outcome" means a decision by a health insurance issuer that is subject to insurance regulatory standards enforced by the Insurance Department that adversely impacts the consumer in a manner that violates those standards or any claim denial;36 Okl. St. § 6568(1) issued by a health insurance issuerHealth insurance issuer"Health insurance issuer" means the same as described in Section 103 of Title 36 of the Oklahoma Statutes;36 Okl. St. § 6568(5). A health insurance issuerHealth insurance issuer"Health insurance issuer" means the same as described in Section 103 of Title 36 of the Oklahoma Statutes;36 Okl. St. § 6568(5) authorized to do business in this state shall not issue an adverse consumer outcomeAdverse consumer outcome"Adverse consumer outcome" means a decision by a health insurance issuer that is subject to insurance regulatory standards enforced by the Insurance Department that adversely impacts the consumer in a manner that violates those standards or any claim denial;36 Okl. St. § 6568(1) with regard to denial, reduction, or termination of health insurance coverageHealth insurance coverage"Health insurance coverage" means benefits consisting of medical care and items and services paid for as medical care, provided directly, through insurance or through reimbursement, under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer;36 Okl. St. § 6568(4) or benefits that results from the use or application of any AI systemAI system"AI system" means a machine-based system that can, with varying levels of autonomy, for a given set of objectives, generate outputs such as productions, recommendations, content such as text, images, videos, or sounds, or other outputs influencing decisions made in real or virtual environments. AI system includes the term artificial intelligence;36 Okl. St. § 6568(2). Any review process concerning denial, reduction, or termination of insurance plans or benefits that results from the use of AI systemsAI system"AI system" means a machine-based system that can, with varying levels of autonomy, for a given set of objectives, generate outputs such as productions, recommendations, content such as text, images, videos, or sounds, or other outputs influencing decisions made in real or virtual environments. AI system includes the term artificial intelligence;36 Okl. St. § 6568(2) shall be reviewed by a licensed professional and all such final decisions shall be issued by a licensed professional. A health insurance issuerHealth insurance issuer"Health insurance issuer" means the same as described in Section 103 of Title 36 of the Oklahoma Statutes;36 Okl. St. § 6568(5) shall provide a disclosure notice to the claimant that such final decision was issued by a professional, not an AI systemAI system"AI system" means a machine-based system that can, with varying levels of autonomy, for a given set of objectives, generate outputs such as productions, recommendations, content such as text, images, videos, or sounds, or other outputs influencing decisions made in real or virtual environments. AI system includes the term artificial intelligence;36 Okl. St. § 6568(2).
(B) 2 No insurer shall issue a final adverse consumer outcomeAdverse consumer outcome"Adverse consumer outcome" means a decision by a health insurance issuer that is subject to insurance regulatory standards enforced by the Insurance Department that adversely impacts the consumer in a manner that violates those standards or any claim denial;36 Okl. St. § 6568(1) on a claim without consulting with the claimant's provider on medical necessityMedical necessity"Medical necessity" means the same as defined in Section 7310 of Title 63 of the Oklahoma Statutes.36 Okl. St. § 6568(6). All final decisions on medical necessityMedical necessity"Medical necessity" means the same as defined in Section 7310 of Title 63 of the Oklahoma Statutes.36 Okl. St. § 6568(6) shall be made by a licensed health care provider, not an insurer. Such provider shall have the opportunity to review all non-privileged information relating to such claim.
(C) The Commissioner may investigate and review the development, investigation, and use of AI systemsAI system"AI system" means a machine-based system that can, with varying levels of autonomy, for a given set of objectives, generate outputs such as productions, recommendations, content such as text, images, videos, or sounds, or other outputs influencing decisions made in real or virtual environments. AI system includes the term artificial intelligence;36 Okl. St. § 6568(2) necessary to ensure compliance with this act.
(D) Any insurer who violates any provisions of this act may be subject to a fine not more than Ten Thousand Dollars ($10,000.00) per violation.
(E) The Commissioner may promulgate rules necessary to enforce the provisions of this act.
Section 6569 is the operative core of the bill. Subsection (A) imposes three interlocking requirements: first, that every final adverse consumer outcome must be issued by a licensed professional; second, that health insurance issuers may not issue adverse consumer outcomes regarding denial, reduction, or termination of coverage or benefits that result from the use of any AI system; and third, that any review process involving AI must be reviewed and decided by a licensed professional. The subsection also requires insurers to disclose to claimants that the final decision was issued by a professional, not an AI system.
Subsection (B) addresses medical necessity specifically, requiring that no insurer issue a final adverse consumer outcome without consulting the claimant's provider on medical necessity, and mandating that all final medical necessity decisions be made by a licensed health care provider — not the insurer. The treating provider must be given access to all non-privileged claim information.
Subsections (C) through (E) establish the enforcement framework: the Insurance Commissioner may investigate and review insurer AI use, violators face fines up to $10,000 per violation, and the Commissioner may promulgate implementing rules.
It being immediately necessary for the preservation of the public peace, health or safety, an emergency is hereby declared to exist, by reason whereof this resolution shall take effect and be in full force from and after its passage and approval.
Section 3 declares an emergency, providing that the act takes effect immediately upon passage and approval rather than on a standard delayed effective date. This is a standard Oklahoma emergency clause.