Washington (May 20, 2025)
ӰƵ Survey Reveals Majority of Health Insurers Embrace AI
The ӰƵ (ӰƵ) today announced the release of its Artificial Intelligence and Machine Learning (AI/ML) Survey Report, offering a comprehensive overview of how health insurers are leveraging AI/ML technologies. The report explores key areas, including the extent of AI/ML adoption, the involvement of third-party developers, the structure of AI governance frameworks, and how these frameworks align with the ӰƵ’s AI Principles and Model Bulletin.
The survey, conducted by 16 states, reveals that 84% of health insurers report they currently utilize artificial intelligence and machine learning (AI/ML) in some capacity. These tools are being applied across a range of healthcare product lines, including individual major medical, group major medical, and student health plans.
“Completion of this survey is a key milestone in regulators’ work on the insurance industry’s use of AI,” stated Michael Humphreys, Pennsylvania Insurance Commissioner and chair of the Big Data and Artificial Intelligence (H) Working Group. “That said, the work of the ӰƵ is not done. Pennsylvania and regulators across the country are working together to best protect consumers. The Working Group released a request for information and urges stakeholders to comment on whether to pursue a model law/regulation to provide additional detail on regulators’ expectations for corporate governance, transparency, and consumer protection.”
Health insurers report they currently use or are exploring AI/ML for several reasons, including:
· Utilization management practices
· Implementing disease management programs
· Prior authorization processes
· Fraud claim detection
· Medical provider fraud detection
· Enhancing online sales, quoting, and shopping experiences through sales and marketing solutions
Additionally, the survey found that nearly 92% of surveyed U.S. health insurers have AI/ML governance principles in place that model ӰƵ AI Principles. These guiding principles promote accountability, transparency, security, and privacy. Health insurers report using AI/ML for testing model drift and bias, cross-validating for accuracy, and analyzing data for completeness and consistency. They also report leveraging AI/ML to conduct equity and compliance audits, with human oversight integrated into AI-driven decision-making.
The Health AI/ML Survey supports the Big Data and Artificial Intelligence (H) Working Group’s charge to research the use of big data and AI/ML (including machine learning) in the insurance business and consider updates to AI oversight in the current regulatory framework.
“ӰƵ members first approved principles for AI and later adopted a model bulletin that provided specific guidance on the application of insurance laws to AI, which nearly 30 states have already enacted,” said Commissioner Humphreys. “All the while, the Working Group has been studying insurers’ use of AI, deliberately moving across the major lines of business. The results show that more and more companies are using AI and are cognizant of applicable state regulations and guidance in the process.”
Methodology
The survey, conducted online from November 2024 to January 2025, included responses from 93 insurance companies. It was carried out under the market examination authority of 16 participating states—Colorado, Connecticut, Illinois, Iowa, Louisiana, Maryland, Minnesota, Nebraska, North Dakota, Oklahoma, Oregon, Pennsylvania, Vermont, Virginia, West Virginia, and Wisconsin.
Insurer participants met at least one of the following criteria:
- Reported over $250 million in earned premiums nationwide in 2023 and currently write business in at least one of the participating states, or
- Represent a significant share of the market in one or more relevant lines of business within those states.
The full report, titled Health AI/ML Survey Report, May 2025, is available on the ӰƵ website.
About the ӰƵ
As part of our state-based system of insurance regulation in the United States, the ӰƵ (ӰƵ) provides expertise, data, and analysis for insurance commissioners to effectively regulate the industry and protect consumers. The U.S. standard-setting organization is governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the ӰƵ, state insurance regulators establish standards and best practices, conduct peer reviews, and coordinate regulatory oversight. ӰƵ staff supports these efforts and represents the collective views of state regulators domestically and internationally.