Legislators across the country have begun filing bills for 2026, including some aimed at regulating AI within the healthcare and insurance industry. So far, three new bills have been introduced which aim to set rules around AI decision making.
Florida House Bill 527 (Senate Bill 202) would allow workers’ compensation carriers, insurers, and HMOs to use algorithms, AI systems, and machine learning systems to assist in processing claims. The bill prohibits the use of these tools as the sole basis for determining whether to reduce claim payment, deny claims, or to portion the claim. Qualified human professionals would be required to finalize these decisions
Additionally, carriers, insurers, and HMOs would be required to include certain information in denial communications to claimants. The bill also authorizes the Department of Financial Services (DFS) and the Office of Insurance Regulation (OIR) to conduct examinations & investigations. Furthermore, the bill would require the disclosure of AI use to claimants. If enacted, this bill would be effective July 1, 2026.
Pennsylvania House Bill 1925 would require human review for insurance and healthcare decisions involving AI. The bill states that AI-based algorithms cannot supersede human healthcare provider clinical decision making, that such algorithms must be fairly and equitably applies, must not discriminate against patients in violate of State or Federal law, and that their performance must be periodically reviewed for accuracy and reliability.
Facilities that use AI to generate claims communications would be required to list a disclaimer that such communications were generated with AI, and provide clear instructions on how to contact a human healthcare provider or relevant employee of the facility within question.
If enacted, this bill would go into effective one year after the enactment date.
And finally, New Hampshire House Bill 1406 would prohibit AI from overriding clinical judgment in health insurance decisions. Furthermore, carrier would be required to maintain records identifying the use of artificial intelligence tools in claims processing and make such records available to the insurance department upon audit. Violations may result in fines or restitution for care delays.
If enacted, this bill would go into effect January 1, 2027.
By defining how AI can be applied claims processing, it reduces compliance uncertainty but also raises the bar for transparency and human oversight. This trend signals growing scrutiny of automated decision-making across insurance and healthcare, making it critical to stay proactive and anticipate operational impacts and adapt proactively.
