Maryam Ramezani-a, Ahad Bakhtiari, Mohammadreza Mobinizadeh, Rajabali Daroudi, Hamid R. Rabiee, Alireza Olyaeemanesh, Ali Akbar Fazaeli, Hakimeh Mostafavi, Maryam Ramezani-b, Saharnaz Sazgarnejad, Sanaz Bordbar, Amirhossein Takian
INTRODUCTION: The rapid evolution of technology has reshaped the insurance industry, with artificial intelligence (AI) taking center stage as a key driver of innovation. This paper examines the transformative impact of AI in health insurance, focusing on its applications and potential to revolutionize the sector. METHOD: This scoping review examines literature published between 2000 and 2024, focusing on the application of AI in health insurance. We used relevant keywords related to artificial intelligence and health insurance to search the PubMed, Scopus, and Web of Science databases. FINDINGS: AI presents numerous opportunities in health insurance, including contributions to shaping international and national agendas, such as aligning goals, establishing indicators, and achieving objectives, financial management, fraud detection, monitoring capabilities, diagnostics and medical innovations, private insurance applications, risk management, technical analysis, and value creation. However, there are ethical challenges that must be addressed if AI is to be effectively implemented. CONCLUSION: Policies for AI applications in health insurance should prioritize the protection of personal health and medical data, address ethical concerns, and ensure robust data privacy and security. Additionally, these policies should promote the use of AI to enhance customer experiences, optimize risk selection, and generate revenue for both insurers and policyholders.