First provisions of health-care overhaul rolling out

Soon, artist Theresa BrownGold and her husband will have one less bill to pay - the monthly premium for their adult son's health insurance.

"It's a great weight off our mind," she said. Her son, a 2008 college graduate, lost his coverage under his family's plan when he turned 23 in May 2009.

While the most significant provisions of the health-care bill passed in March won't kick in until 2014, some significant provisions will begin to roll out starting Thursday, the sixth-month anniversary of the passage of the federal Patient Protection and Affordable Care Act.

The one that thrills BrownGold is the provision that young adults can stay on their parents' coverage until age 26 - and in some cases in Pennsylvania, until 29.

"We, as parents, have fantastic peace of mind," said BrownGold, who spoke at a session Monday on the new provisions.

Other speakers included Joanne Grossi, regional director for the U.S. Department of Health and Human Services; Kathleen Stoll, deputy director of the advocacy group Families USA; and Valerie Arkoosh, a Philadelphia anesthesiologist who heads the National Physicians Alliance.

BrownGold's son, Max, lives independently, earning his way with a series of part-time jobs, none of which offers health insurance.

He was willing to take the risk of being uninsured, but his parents were not, knowing full well that if he got hurt or sick, they would end up footing the bill. They imagined the worst - bankruptcy or losing their home. "We saw everything going up in smoke," she said.

Caveats abound. Some changes, for example, do not take effect until open-enrollment periods occur, or until a new policy year begins.

Other employer plans don't have to incorporate the changes because they are "grandfathered," meaning they were in effect on March 23, when the legislation was signed. If the company doesn't make major changes to its existing plan, the plan can retain its "grandfather" status.

And the biggest caveat? The legislation itself is under attack by Republicans who want to roll it back, saying it is too expensive.

Stoll listed other provisions beginning to take effect this week:

Insurers will not be able to turn away children under 19 because of preexisting conditions. That proviso will extend to adults in 2014. Meanwhile, some states, including Pennsylvania, are offering bridge plans for adults with preexisting conditions.

Health plans must cover recommended preventive services, such as colonoscopies, mammograms, and flu shots, with no co-pay.

Insurers cannot drop people when they become sick just because they made a mistake when filling out an insurance application.

Lifetime caps on coverage will no longer be allowed. People who have reached those caps can reapply for coverage. Annual limits will be regulated.

All new plans will have to include new rules about internal and external appeal processes when consumers disagree with coverage decisions. In states where these provisions exist, "consumers win 45 percent of the time" when there is an external review, Stoll said.

Women can see their gynecologists without prior approval from a primary-care doctor, and all managed-care plans must allow patients to choose their doctors within the network.

When people encounter an emergency while traveling, they can seek treatment at the closest place without having to worry about out-of-network surcharges.