The National Association of Insurance Commissioners (NAIC) released its Artificial Intelligence and Machine Learning (AI/ML) Survey Report on health insurers’ use of AI/ML, covering adoption levels, third-party involvement, governance frameworks and alignment with the NAIC’s AI Principles and Model Bulletin. Based on a survey run by 16 states, 84% of responding health insurers reported using AI/ML in some capacity across product lines including individual and group major medical and student health plans, and nearly 92% reported having AI/ML governance principles modeled on NAIC AI Principles. Reported use cases included utilization management, disease management, prior authorization, fraud claim detection and medical provider fraud detection, as well as sales and marketing tools to enhance online quoting and shopping. Insurers also reported governance and control practices such as testing for model drift and bias, cross-validating for accuracy, assessing data completeness and consistency, running equity and compliance audits and integrating human oversight into AI-driven decision-making. The NAIC’s Big Data and Artificial Intelligence (H) Working Group is using the results to support its work on potential updates to AI oversight within the existing regulatory framework and has issued a request for information seeking stakeholder views on whether to pursue a model law or regulation to provide additional detail on expectations for corporate governance, transparency and consumer protection.
National Association Of Insurance Commissioners 2025-05-20
National Association of Insurance Commissioners releases health insurer AI survey finding 84% adoption and signalling possible model law follow-up
The NAIC report shows 84% of health insurers use AI/ML across product lines, with 92% aligning with NAIC AI Principles. It highlights fraud detection, sales tools, and governance practices. The NAIC's Big Data and AI Working Group seeks stakeholder input on potential model law or regulation for AI oversight and consumer protection.