The bill H. 5206 aims to amend the South Carolina Code of Laws by adding Article 25 to Chapter 71, Title 38, which establishes guidelines for health insurers using artificial intelligence (AI) in making prior authorization determinations. It defines key terms such as "artificial intelligence," "enrollee," and "health benefit plan," and outlines the responsibilities of insurers when utilizing AI. Insurers must consider the enrollee's medical history and unique clinical circumstances when making determinations, and these decisions must be certified annually to the Department of Insurance to ensure compliance with fairness and non-discrimination standards.

Additionally, the bill mandates that insurers disclose the use of AI in their processes to enrollees and provides for disciplinary actions if violations occur. If the Department of Insurance finds that an insurer has not adhered to these requirements, it can impose corrective measures or disciplinary actions for repeat violations. The bill emphasizes the importance of human oversight in the decision-making process, requiring that any denial or modification of prior authorization requests be made by a licensed healthcare professional who can evaluate the AI's recommendations in the context of the specific clinical issues presented.