The following words and phrases when used in this act shall have the meanings given to them in this section unless the context clearly indicates otherwise: "Artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms." 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.Section 2." 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. "CommissionerCommissioner"Commissioner." The Insurance Commissioner of the Commonwealth.Section 2." The Insurance Commissioner of the Commonwealth. "Covered personCovered person"Covered person." A policyholder, subscriber or other individual who is entitled to receive health care services under a health insurance policy.Section 2." A policyholder, subscriber or other individual who is entitled to receive health care servicesHealth care service"Health care service." 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.Section 2 under a health insurance policyHealth insurance policy"Health insurance policy." A policy, subscriber contract, certificate or plan issued by an insurer that provides medical or health care coverage. The term does not include: (1) An accident only policy. (2) A credit only policy. (3) A long-term care or disability income policy. (4) A specified disease policy. (5) A Medicare supplement policy. (6) A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy. (7) A fixed indemnity policy. (8) A hospital indemnity policy. (9) A dental only policy. (10) A vision only policy. (11) A workers' compensation policy. (12) An automobile medical payment policy under 75 Pa.C.S. (relating to vehicles). (13) A homeowner's insurance policy. (14) Any other similar policies providing for limited benefits.Section 2. "DepartmentDepartment"Department." The Insurance Department of the Commonwealth.Section 2." The Insurance Department of the Commonwealth. "Health care providerHealth care provider"Health care provider." 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 this Commonwealth.Section 2." 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." 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.Section 2 under the laws of this Commonwealth. "Health care serviceHealth care service"Health care service." 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.Section 2." 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." 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 this Commonwealth.Section 2 to a covered personCovered person"Covered person." A policyholder, subscriber or other individual who is entitled to receive health care services under a health insurance policy.Section 2 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." A policy, subscriber contract, certificate or plan issued by an insurer that provides medical or health care coverage. The term does not include: (1) An accident only policy. (2) A credit only policy. (3) A long-term care or disability income policy. (4) A specified disease policy. (5) A Medicare supplement policy. (6) A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy. (7) A fixed indemnity policy. (8) A hospital indemnity policy. (9) A dental only policy. (10) A vision only policy. (11) A workers' compensation policy. (12) An automobile medical payment policy under 75 Pa.C.S. (relating to vehicles). (13) A homeowner's insurance policy. (14) Any other similar policies providing for limited benefits.Section 2. "Health insurance policyHealth insurance policy"Health insurance policy." A policy, subscriber contract, certificate or plan issued by an insurer that provides medical or health care coverage. The term does not include: (1) An accident only policy. (2) A credit only policy. (3) A long-term care or disability income policy. (4) A specified disease policy. (5) A Medicare supplement policy. (6) A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy. (7) A fixed indemnity policy. (8) A hospital indemnity policy. (9) A dental only policy. (10) A vision only policy. (11) A workers' compensation policy. (12) An automobile medical payment policy under 75 Pa.C.S. (relating to vehicles). (13) A homeowner's insurance policy. (14) Any other similar policies providing for limited benefits.Section 2." A policy, subscriber contract, certificate or plan issued by an insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 that provides medical or health care coverage. The term does not include: (1) An accident only policy. (2) A credit only policy. (3) A long-term care or disability income policy. (4) A specified disease policy. (5) A Medicare supplement policy. (6) A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy. (7) A fixed indemnity policy. (8) A hospital indemnity policy. (9) A dental only policy. (10) A vision only policy. (11) A workers' compensation policy. (12) An automobile medical payment policy under 75 Pa.C.S. (relating to vehicles). (13) A homeowner's insurance policy. (14) Any other similar policies providing for limited benefits. "InsurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2." The following: (1) An entity licensed by the departmentDepartment"Department." The Insurance Department of the Commonwealth.Section 2 that offers, issues or renews an individual or group health insurance policyHealth insurance policy"Health insurance policy." A policy, subscriber contract, certificate or plan issued by an insurer that provides medical or health care coverage. The term does not include: (1) An accident only policy. (2) A credit only policy. (3) A long-term care or disability income policy. (4) A specified disease policy. (5) A Medicare supplement policy. (6) A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy. (7) A fixed indemnity policy. (8) A hospital indemnity policy. (9) A dental only policy. (10) A vision only policy. (11) A workers' compensation policy. (12) An automobile medical payment policy under 75 Pa.C.S. (relating to vehicles). (13) A homeowner's insurance policy. (14) Any other similar policies providing for limited benefits.Section 2 that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care PlanMedical Assistance or CHIP Managed Care Plan"Medical Assistance or CHIP Managed Care Plan." A health care plan that uses a gatekeeper to manage the utilization of health care services by medical assistance or children's health insurance program enrollees and integrates the financing and delivery of health care services.Section 2. "Medical Assistance or CHIP Managed Care PlanMedical Assistance or CHIP Managed Care Plan"Medical Assistance or CHIP Managed Care Plan." A health care plan that uses a gatekeeper to manage the utilization of health care services by medical assistance or children's health insurance program enrollees and integrates the financing and delivery of health care services.Section 2." A health care plan that uses a gatekeeper to manage the utilization of health care servicesHealth care service"Health care service." 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.Section 2 by medical assistance or children's health insurance program enrollees and integrates the financing and delivery of health care servicesHealth care service"Health care service." 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.Section 2. "SpecialistSpecialist"Specialist." 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.Section 2." A health care providerHealth care provider"Health care provider." 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 this Commonwealth.Section 2 whose practice is not limited to primary health care servicesHealth care service"Health care service." 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.Section 2 and who has additional postgraduate or specialized training, has board certification or practices in a licensed specialized area of health care. "Utilization reviewUtilization review"Utilization review." The term shall mean the same as defined under section 2102 of The Insurance Company Law of 1921.Section 2." The term shall mean the same as defined under section 2102 of The Insurance Company Law of 1921.

(a) 1 Duty to disclose.--An insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 shall disclose to a health care providerHealth care provider"Health care provider." 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 this Commonwealth.Section 2, all covered personsCovered person"Covered person." A policyholder, subscriber or other individual who is entitled to receive health care services under a health insurance policy.Section 2 and the general public if artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms." 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.Section 2 are used, not used or will be used in the insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2's utilization reviewUtilization review"Utilization review." The term shall mean the same as defined under section 2102 of The Insurance Company Law of 1921.Section 2 process. An insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 shall disclose information about the use or lack of use of artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms." 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.Section 2 in the utilization reviewUtilization review"Utilization review." The term shall mean the same as defined under section 2102 of The Insurance Company Law of 1921.Section 2 process on the insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2's publicly accessible Internet website.

(b) 2 Transparency.--An insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 shall submit the artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms." 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.Section 2 and training data sets that are being used or will be used in the utilization reviewUtilization review"Utilization review." The term shall mean the same as defined under section 2102 of The Insurance Company Law of 1921.Section 2 process to the departmentDepartment"Department." The Insurance Department of the Commonwealth.Section 2 for transparency. The departmentDepartment"Department." The Insurance Department of the Commonwealth.Section 2 shall implement a process that allows the departmentDepartment"Department." The Insurance Department of the Commonwealth.Section 2 to certify that these artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms." 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.Section 2 and training data sets have minimized the risk of bias based on the covered personCovered person"Covered person." A policyholder, subscriber or other individual who is entitled to receive health care services under a health insurance policy.Section 2'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." 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.Section 2 who participates in a utilization reviewUtilization review"Utilization review." The term shall mean the same as defined under section 2102 of The Insurance Company Law of 1921.Section 2 process for an insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 that initially uses artificial intelligence-based algorithmsArtificial intelligence-based algorithms"Artificial intelligence-based algorithms." 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.Section 2 for a utilization reviewUtilization review"Utilization review." The term shall mean the same as defined under section 2102 of The Insurance Company Law of 1921.Section 2 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) A violation of this act shall be deemed to be an unfair method of competition and an unfair or deceptive act or practice under the act of July 22, 1974 (P.L.589, No.205), known as the Unfair Insurance Practices Act.

(a)(2) Upon satisfactory evidence of a violation of this act by an insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 or other person, one or more of the following penalties may be imposed at the commissionerCommissioner"Commissioner." The Insurance Commissioner of the Commonwealth.Section 2's discretion: (i) Suspension or revocation of license of the insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 or other person. (ii) Refusal, for a period not to exceed one year, to issue a new license to the insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 or other person. (iii) A fine of not more than $5,000 for each violation of this act. (iv) A fine of not more than $10,000 for each willful violation of this act.

(b) Limitations on fines.-- (1) Fines imposed against an insurerInsurer"Insurer." The following: (1) An entity licensed by the department that offers, issues or renews an individual or group health insurance policy that is offered or governed under: (i) The act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV thereof. (ii) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations). (2) The term does not include an entity operating as a Medical Assistance or CHIP Managed Care Plan.Section 2 under subsection (a) may not exceed $500,000 in the aggregate during a single calendar year. (2) Fines imposed against any other person under subsection (a) may not exceed $100,000 in the aggregate during a single calendar year.

(c) Additional remedies.--The enforcement remedies imposed under this subsection are in addition to any other remedies or penalties that may be imposed under any other applicable law of this Commonwealth, including: (1) The Unfair Insurance Practices Act. (2) The act of December 18, 1996 (P.L.1066, No.159), known as the Accident and Health Filing Reform Act. (3) The act of June 25, 1997 (P.L.295, No.29), known as the Pennsylvania Health Care Insurance Portability Act.

(d) Administrative procedure.--This section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of Commonwealth agencies). A party against whom penalties are assessed in an administrative action may appeal to Commonwealth Court as provided in 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial review of Commonwealth agency action).

This act shall take effect in 60 days.