1| STATE OF OKLAHOMA | | | 2| 2nd Session of the 60th Legislature (2026) | | | 3|SENATE BILL 2038 By: Goodwin | | | 4| | | | 5| | | | 6| AS INTRODUCED | | | 7| An Act relating to health insurance; defining terms; | | prohibiting issue of certain outcomes by artificial | 8| intelligence; prohibiting certain health insurance | | issuer from issuing certain outcome from the use of | 9| certain AI system; requiring certain decisions to be | | reviewed by certain licensed health care provider; | 10| requiring certain health insurance issuer to provide | | certain disclosure to certain claimant; allowing | 11| certain promulgation of rules by Insurance | | Commissioner; allowing Commissioner to investigate | 12| and review use of AI by certain issuer; providing for | | codification; and declaring an emergency. | 13| | | | 14| | | | 15|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 16| SECTION 1. NEW LAW A new section of law to be codified | | | 17|in the Oklahoma Statutes as Section 6568 of Title 36, unless there | | | 18|is created a duplication in numbering, reads as follows: | | | 19| As used in this act: | | | 20| 1. "Adverse consumer outcome" means a decision by a health | | | 21|insurance issuer that is subject to insurance regulatory standards | | | 22|enforced by the Insurance Department that adversely impacts the | | | 23|consumer in a manner that violates those standards or any claim | | | 24|denial; | | | Req. No. 3029 Page 1 ___________________________________________________________________________
1| 2. "AI system" means a machine-based system that can, with | | | 2|varying levels of autonomy, for a given set of objectives, generate | | | 3|outputs such as productions, recommendations, content such as text, | | | 4|images, videos, or sounds, or other outputs influencing decisions | | | 5|made in real or virtual environments. AI system includes the term | | | 6|artificial intelligence; | | | 7| 3. "Artificial intelligence" means a computer system, program, | | | 8|or set of algorithms capable of performing tasks on producing | | | 9|outposts that imitate intelligent human behaviors; | | | 10| 4. "Health insurance coverage" means benefits consisting of | | | 11|medical care and items and services paid for as medical care, | | | 12|provided directly, through insurance or through reimbursement, under | | | 13|any hospital or medical service policy or certificate, hospital or | | | 14|medical service plan contract, or health maintenance organization | | | 15|contract offered by a health insurance issuer; | | | 16| 5. "Health insurance issuer" means the same as described in | | | 17|Section 103 of Title 36 of the Oklahoma Statutes; and | | | 18| 6. "Medical necessity" means the same as defined in Section | | | 19|7310 of Title 63 of the Oklahoma Statutes. | | | 20| SECTION 2. NEW LAW A new section of law to be codified | | | 21|in the Oklahoma Statutes as Section 6569 of Title 36, unless there | | | 22|is created a duplication in numbering, reads as follows: | | | 23| A. A licensed professional shall issue any final adverse | | | 24|consumer outcome issued by a health insurance issuer. A health | | | Req. No. 3029 Page 2 ___________________________________________________________________________
1|insurance issuer authorized to do business in this state shall not | | | 2|issue an adverse consumer outcome with regard to denial, reduction, | | | 3|or termination of health insurance coverage or benefits that results | | | 4|from the use or application of any AI system. Any review process | | | 5|concerning denial, reduction, or termination of insurance plans or | | | 6|benefits that results from the use of AI systems shall be reviewed | | | 7|by a licensed professional and all such final decisions shall be | | | 8|issued by a licensed professional. A health insurance issuer shall | | | 9|provide a disclosure notice to the claimant that such final decision | | | 10|was issued by a professional, not an AI system. | | | 11| B. No insurer shall issue a final adverse consumer outcome on a | | | 12|claim without consulting with the claimant's provider on medical | | | 13|necessity. All final decisions on medical necessity shall be made | | | 14|by a licensed health care provider, not an insurer. Such provider | | | 15|shall have the opportunity to review all non-privileged information | | | 16|relating to such claim. | | | 17| C. The Commissioner may investigate and review the development, | | | 18|investigation, and use of AI systems necessary to ensure compliance | | | 19|with this act. | | | 20| D. Any insurer who violates any provisions of this act may be | | | 21|subject to a fine not more than Ten Thousand Dollars ($10,000.00) | | | 22|per violation. | | | 23| E. The Commissioner may promulgate rules necessary to enforce | | | 24|the provisions of this act. | | | Req. No. 3029 Page 3 ___________________________________________________________________________
1| SECTION 3. It being immediately necessary for the preservation | | | 2|of the public peace, health or safety, an emergency is hereby | | | 3|declared to exist, by reason whereof this resolution shall take | | | 4|effect and be in full force from and after its passage and approval. | | | 5| | | | 6| 60-2-3029 CAD 1/15/2026 12:45:45 PM | | | 7| | | | 8| | | | 9| | | | 10| | | | 11| | | | 12| | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | Req. No. 3029 Page 4