Relating to the use of certain automated systems in, and certain adverse determinations made in connection with, the health benefit claims process.

Summary

The bill bars utilization review agents from using automated decision systems, including AI, to make any part of a denial of health‑benefit claims. It also requires insurers to give patients detailed reasons, clinical basis, screening criteria, and appeal information when a denial occurs. The law applies to health plans issued or renewed on or after Jan. 1, 2026 and takes effect Sep. 1, 2025.

AI-generated summary — may be incomplete or inaccurate. Verify against the official bill text.

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