For many people, trying to understand dental benefit plans can be frustrating. Many people don't know what their plan provides, and complicating matters further is the growth in the number of dental benefit plans.

Employers offer dental benefits to attract and retain qualified employees. Listed below are several questions that every employee should ask their employer about their dental benefit paln.

• What does my dental benefit plan cover?

Find out before you go in for your first dental visit exactly what your employer's dental benefit plan covers. Review the paln with your employer to determine the benefit levels, exclusions and/or limitations of coverage and who is covered by the paln.

• If my dentist is not on the list of dentists provided by my employer can I still go to him or her for treatment?

You should be able to always go to the dentist of your choice for treatment. The question if whether the benefit plan offered by your employer will pay for treatment given you by a dentist not on the list. Under some plans patients are given a finacial incentative to go to certain dentists but do receive some level of dental benefit if they go to a dentist who is not on the list.

Other plans, such as capitation programs, do not provide any benefit coverage for treatment given by "non-participating" dentists. The American Dental Association believes that patients should have the annual option to choose a plan that affords unrestricted choice of dentists, with comparable benefits and equal premium dollars.

• My dentist recommends a treatment that my plan will not pay for. Does this mean the treatment isn't necessary?

No. Your dentist has recommended the treatment plan that he or she believes is best suited to your oral health needs. However, it is common for dental plans not to cover some treatments that are covered under the company's medical paln. Some dental plans also exclude or discourage necessary dental treatment such as treatment for pre-existing conditions, sealants, adult orthodontics and specialists referrals. Patients need to be aware of the exclusions and limitations in their dental plans but should not allow those factors alone to determine their treatment decisions. Ask your employer to encourage full coverage for preventive procedures such as sealants and flouride applications.

• My dentist recommends that I get a crown on a tooth, but my dental benefit plan will only pay for a large filling for that tooth. Which treatment should I have?

 Some plans will provide only the level of benefit that allows for the least expensive way to treat a dental need, regardless of the decision made by you and your dentist. Sometimes special circumstances may be explained to the third-party payer to request an adjustment to this lower benefit allowance, but there is no guarantee that the third-party payer will alters its coverage.

• I do not have dental benefits and need some major dental work. Where can I buy individual dental insurance?

Individual dental benefits plans are not common because dental needs are highly predictable. However, there are a few companies that offer a form of dental benefits for individuals. Most of these plans are "referral plans" or "buyers clubs." Under these plans, an individual pays a monthly fee to a third party in return for a list of dentists who have agreed to a reduced fee schedule. Payment for treatment is made from the patient directly to the dentist. The third party merely matches the individual to the dentist. The dentist typically receives no payment from the third party other than in the form of referral of patients. Before agreeing to pay any fee or membership, you should ask for the list of dentists and call to see if, in fact, they have agreed to accept patient referrals from the plan your considering.

• Okay, if it's likely I'll find one of these buyer's clubs, how should I go about asking my employer to provide dental benefits?

If your employer currently offers a dental benefit plan, or is considering a dental benefit paln, the ADA's Council on Dental Benefit Programs will review the proposed or existing plan and make suggestions for improvement.

Your employer may contact the American Dental Associations Council on Dental Benefits Programs, Purchaser Inforamtion Service, 211 East Chicago Avenue, Chicago, Illinois 60611: 312/440-2746.