What Connecticut announced
Connecticut Comptroller Sean Scanlon on 16 September announced rules governing how health insurers that administer the state employee health plan may use artificial intelligence. They will apply to more than 270,000 people enrolled in the state employee plan and the Connecticut Partnership Plan, which covers municipal and other public-sector workers, CT Mirror reports. The rules take effect on 1 January 2027.
The insurers covered include Anthem, which handles medical benefits for active employees, Cigna for dental coverage, Aetna for retirees’ Medicare Advantage plans and Caremark for pharmacy benefits.
The five policies
According to WSHU, the rules:
- require a human review of adverse decisions, so AI cannot be the sole basis for them;
- bar carriers from using AI or predictive models as the sole basis to down-code claims, reduce provider payments or alter billing codes without human review;
- require insurers to protect members’ privacy, and CT Mirror reports that member data may not be used to train other AI models;
- require person-to-person communication with members;
- require transparency audits of how accurate the AI systems are, with carriers disclosing their governance and audit procedures to the comptroller.
“Our world is changing rapidly and government needs to change with it at the same speed in order to protect people,” Scanlon said.
Why it matters, and its limits
The rules use the state’s purchasing power rather than new law: the comptroller runs the plans and can set terms for the insurers that administer them. That also limits their reach. CT Mirror notes that about 220,000 Connecticut residents, 6% of the population, are covered by state-regulated plans, and that federal law puts the self-funded plans of large employers outside state control.
Scanlon plans to recommend in January 2027 that lawmakers extend the same protections to all state-regulated health plans. Whether the legislature takes that up in its next session is the next step to watch.
