IL SB1642

Amends the Illinois Insurance Code sections 143.31 and 368c regarding explanation of benefits statements, claims summary statements, and remittance advice furnished by health insurers.

Requires explanation of benefits statements to clearly identify all reductions including deductibles, copayments, coinsurance, administrative fees, and withholds in separately marked columns with reasons for denials or reductions.

Mandates that items and amounts on explanation of benefits must match and be consistent with corresponding remittance advice sent to health care providers so patients see all reductions in actual payments to providers.

Prohibits insurers from issuing explanations of benefits stating payment has been made to a provider unless actual payment has been made; requires preliminary and final explanations of benefits when payment will be delayed.

Expands definition of payors required to furnish remittance advice to include health maintenance organizations, managed care plans, preferred provider organizations, third party administrators, and independent practice associations.