WHAT THIS BILL REGULATES · 3 REQUIREMENT TYPES
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.
A "Artificial intelligenceArtificial intelligence"Artificial intelligence" or "AI" means a branch of computer science that uses data processing systems that perform functions normally associated with human intelligence, such as reasoning, learning, and self-improvement, or the capability of a device to perform functions that are normally associated with human intelligence, such as reasoning, learning, and self-improvement. "Artificial intelligence" includes machine learning.Va. Code § 38.2-3407.15(A)" or "AI" means a branch of computer science that uses data processing systems that perform functions normally associated with human intelligence, such as reasoning, learning, and self-improvement, or the capability of a device to perform functions that are normally associated with human intelligence, such as reasoning, learning, and self-improvement. "Artificial intelligenceArtificial intelligence"Artificial intelligence" or "AI" means a branch of computer science that uses data processing systems that perform functions normally associated with human intelligence, such as reasoning, learning, and self-improvement, or the capability of a device to perform functions that are normally associated with human intelligence, such as reasoning, learning, and self-improvement. "Artificial intelligence" includes machine learning.Va. Code § 38.2-3407.15(A)" includes machine learning.
Subsection A contains the definitions applicable to § 38.2-3407.15. The bill adds a new definition of "artificial intelligence" (or "AI") to this subsection, defining it broadly as a branch of computer science using data processing systems that perform functions normally associated with human intelligence, including machine learning. Existing definitions for carrier, enrollee, provider, claim, clean claim, health care services, health plan, provider contract, and retroactive denial remain unchanged.
(15)(i) 1 Each carrierCarrier"Carrier," "enrollee," and "provider" shall have the meanings set forth in § 38.2-3407.10; however, a "carrier" shall also include any person required to be licensed under this title which offers or operates a managed care health insurance plan subject to Chapter 58 (§ 38.2-5800 et seq.) or which provides or arranges for the provision of health care services, health plans, networks or provider panels which are subject to regulation as the business of insurance under this title.Va. Code § 38.2-3407.15(A) shall (i) publicly disclose, if applicable, to the Bureau the carrierCarrier"Carrier," "enrollee," and "provider" shall have the meanings set forth in § 38.2-3407.10; however, a "carrier" shall also include any person required to be licensed under this title which offers or operates a managed care health insurance plan subject to Chapter 58 (§ 38.2-5800 et seq.) or which provides or arranges for the provision of health care services, health plans, networks or provider panels which are subject to regulation as the business of insurance under this title.Va. Code § 38.2-3407.15(A)'s use of AI to manage insurance claims and coverage, including in underlying algorithms, data used, and resulting determinations;
(15)(ii) 2 submit to the Bureau, upon request, all information, including documents and software, necessary for enforcement of this subdivision;
(15)(iii) 3 maintain documentation of AI decisions for at least three years; and
(15)(iv) 4 provide notice to enrollees and health care providers when AI has been used to issue an adverse determination and provide a clear and timely process for appealing the determination.
New subdivision B 15 imposes four distinct AI-related obligations on health carriers. Clause (i) requires public disclosure to the Bureau of Insurance regarding the carrier's use of AI in managing insurance claims and coverage, including the underlying algorithms, data used, and resulting determinations. Clause (ii) requires carriers to submit all information — including documents and software — necessary for the Bureau's enforcement upon request. Clause (iii) mandates that carriers maintain documentation of AI decisions for at least three years. Clause (iv) requires notice to enrollees and providers when AI has been used to issue an adverse determination, along with a clear and timely appeal process.
These obligations are embedded within the existing fair business standards framework, meaning violations carry the same enforcement mechanisms and remedies as other subsection B violations — including the provider private right of action under subsection G and regulatory oversight by the State Corporation Commission.