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For the purposes of the Business Travel Accident Plan and the Voluntary Accident Insurance Plan, an accident is a sudden, unforeseen, and unexpected event that happens by chance and arises from a source that is external to the insured person. It must be the direct cause of the loss or the loss of use and be independent of illness, disease, or other bodily malfunction. You are considered actively at work on any day on which you are physically and mentally fit to perform all the usual and customary duties of your occupation with Ryerson. This includes a scheduled working day when you are not present at work but you are capable of working (i.e., you are not in hospital or disabled or ill), or a day when you are not scheduled to work if, on your last scheduled working day you were actively at work. This is a voluntary, employee paid plan that covers accidental death & dismemberment 24/7. It is available as single or family coverage in units of 1-50. Each unit is $10,000. Maximum coverage is $500,000. This is one method of paying for benefit coverage. The plan sponsor reimburses the insurance company for all claims paid, plus administration fees & taxes. If the liability or risk can be reasonably measured and cash flow fluctuation is not an issue, than the sponsor is only paying for what has been utilized. The risk to the sponsor is for a catastrophic claim in the tens of thousands of dollars. At Ryerson, the medical and dental benefits are paid for on an ASO basis. Your basic annual earnings include your current salary from Ryerson. It excludes any bonus, commission, overtime, or incentive pay you may receive. A beneficiary refers to the person who will receive the loss of life benefit from a benefits plan if you die (e.g., the lump sum from a life insurance plan or the loss of life benefit under an accident insurance plan). Under the Voluntary Accident Insurance Plan, if you have not named a beneficiary, the first surviving person(s) in the list below will receive your loss of life benefit, in the following order:

• Your spouse;
• In equal shares to your children;
• In equal shares to your parents;
• In equal shares to your siblings;
• To your estate.

You would receive any accident insurance benefits other than the loss of life benefit. The benefit year is January 1 to December 31, inclusive. A calendar year is January 1 to December 31, inclusive. See dependent child If your spouse has group benefits coverage with another insurance company, or with Ryerson University through Sun Life Financial, benefits are coordinated between the two insurance plans. Details on coordination of benefits can be found on the HR website. The deductible is the amount you pay out of pocket before the plan begins paying for covered expenses. The deductible is $25/year excluding hospital expenses. Coverage for dental expenses. There is no provincial plan for dental expenses. The plan is an ASO arrangement with Sun Life and Ryerson pays 100% of the costs. Dependent children may be insured under the Ryerson benefits program for medical and dental benefits and voluntary accident insurance. The term dependent child means an unmarried child

• who is under 21 years of age and depends on you for support; or
• who is under 25 years of age, depends on you for support, and is attending an institution of higher learning* as a full-time student; or
• who is any age (if covered before age 21, or before age 25 if a student) and who is permanently mentally or physically disabled and incapable of self-support.**

Stepchildren and legally adopted children are eligible if they depend on you for support. Children of a common-law spouse are eligible during the time that coverage for the spouse is in effect and if the children depend on you for support.
* You must provide confirmation of the child's enrollment in full-time studies at an educational institution recognized by the Canada Revenue Agency, to the Human Resources Benefits Unit.
** You must obtain and complete a Disabled Dependent Questionnaire from Sun Life for any dependent child(ren) who is/are permanently mentally or physically disabled. Your dependents include your spouse and dependent children as defined elsewhere in this glossary. The amount that the pharmacist charges to dispense a prescription drug. A doctor is a person who is licensed as a medical doctor or a doctor of osteopathy under the laws of the jurisdiction where treatment is given and who is qualified to provide the medical treatment. Doctor does not include a family member of the insured person, a social worker, a physiotherapist, or a chiropractor. Under the Voluntary Accident Insurance Plan the term domestic partner means a person

• who is at least 18 years of age,
• who has been in a committed relationship with you throughout the past 12 months,
• who has been your sole spousal equivalent,
• who has lived in the same household as you, and
• who intends to continue the relationship described above indefinitely.

Extended Health Care. Designed to complement provincial health plans (OHIP/UHIP). Coverage for many medical expenses above what is provided by OHIP/UHIP. The plan is an ASO arrangement with Sun Life and Ryerson pays 100% of the costs. In the Long Term Disability Plan policy, this term refers to a "waiting period” before LTD benefits can begin and usually coincides with the period of time during which Sick Leave benefits are payable, although there are some exceptions. The elimination period begins with the first full day of total disability and ends

• after a period of total disability of 66 working days, or
• on the last day that a benefit under any loss of income or salary continuance plan is payable, if earlier.

If your total disability starts while you are on strike; temporary layoff; an approved leave of absence without pay; or a period of absence recognized as the normal non-work period if you are working a reduced workload or partial year; the elimination period begins on the date you would have normally been scheduled to return to work.
If you are considered to be a reduced workload or partial year employee, and your total disability starts while you are actively at work and continues until the date recognized as the non-work period, the elimination period will be suspended, if not yet completed, and will restart on the date you would have normally been scheduled to return to work.
If your total disability starts while you are on an approved leave of absence with pay, the elimination period begins on the date you become totally disabled.
In the case of pregnancy, the elimination period starts on the earlier of the date pregnancy terminates and the date the employee is totally disabled. An emergency is an acute unexpected condition, illness, disease, or injury that requires immediate assistance. An employee is a person employed by Ryerson. An employee must reside in Canada, or may temporarily reside outside Canada if on a leave of absence approved by Ryerson. Anyone who is not entitled to benefits under either a provincial health care plan (e.g., OHIP or UHIP, see definition below) or a federal government plan that provides similar benefits is not considered to be an employee for purposes of health coverage. The fee guide of the Ontario Dental Association (ODA) lists procedure codes that identify individual treatments performed by dentists in Ontario. The guide also provides a recommended fee for each treatment. Sun Life, the carrier for the Ryerson Dental Plan, refers to the current ODA fee guide to determine the maximum the Plan will pay for each dental service. In the case of laboratory fees, the Plan will reimburse 66 2/3% of the procedure fee listed in the current fee guide. A hospital is a public institution, building, or place providing treatment for or attempting to cure a person suffering from an illness and requiring continuous confinement. This includes similar places providing specialized treatment for convalescing or chronically ill persons when approved by Sun Life. This does not include nursing homes, homes for the aged, rest homes, or other places providing similar care. An illness is a bodily injury, disease, mental infirmity, or sickness. Under the Business Travel Accident Insurance Plan and the Voluntary Accident Insurance Plan, a loss is as follows:

• Arms and legs - severance through or above elbow or knee joints.
• Feet - severance through or above ankle joints.
• Hand - severance through or above the knuckle joints of at least four fingers on the same hand or at least three fingers and the thumb on the same hand.
• Thumb and index finger of the same hand - severance through or above knuckle joint of each digit.
• Toes - severance through or above metatarsophalangeal joints.
• Sight - entire and irrecoverable loss of sight. Remaining vision in that eye must be no better than 20/200 using a corrective aid or device, as determined by a doctor.
• Speech and hearing - permanent, irrecoverable, and total loss, without the aid of mechanical devices, as determined by a doctor.
• Quadriplegia, paraplegia, hemiplegia – complete and irreversible loss of all motion and all practical use of an arm or leg that is continuous for 12 months, as determined by an doctor.

If a limb, hand, foot, thumb, or index finger is later reattached, the original loss is still considered an eligible loss under the policy. Under the Business Travel Accident Plan and the Voluntary Accident Insurance Plan, loss of use means the total and irrecoverable loss of use of a body part. For benefits to be payable, the loss of use must continue for 12 consecutive months after which the benefit for loss of use is payable, and nerve damage must be determined to be permanent afterward. A minor is someone who is less than 18 years old. This government-operated program provides health insurance for Ontarians. It pays for ward accommodation in hospitals and for most routine medical services.
Enrollment is handled directly by OHIP. Each member of your family (even children under 21 years of age) who is covered by OHIP should have his or her own individual OHIP health card.
Information about OHIP coverage and the covered services and supplies is available from the Ontario Ministry of Health and Long-Term Care. Coverage is provided while employees are out of the province and require medical care. An emergency means an acute illness or accidental injury that requires immediate, medically necessary treatment prescribed by a doctor. Having a heart attack while vacationing in Florida would be covered; needing regular dialysis treatment would not. Ryerson has insured a portion of this benefit so that if aggregate claims exceed $40,000, the remainder of any claims are insured (i.e. does not show up on the ASO statement). A premium is the amount of money that a plan participant or an employer pays to an insurance company for a specified amount of insurance coverage. A drug that has a drug identification number (DIN) and is prescribed in writing by a doctor. A revocable beneficiary is a beneficiary designation which you have the right to change at any time without the beneficiary’s consent. The Ryerson Faculty Association represents full-time and probationary faculty, professional counselors, and librarians. Your spouse may be insured under the Ryerson benefits program for medical and dental benefits and voluntary accident insurance.
Your spouse is either
(a) the person to whom you are married by virtue of a legal marriage or under any other formal union recognized by law, or
(b) a person of the opposite sex or of the same sex who is publicly represented as your spouse and has been continually so represented for at least the previous year.*
Under the Voluntary Accident Insurance Plan, the term "spouse" also includes "domestic partner” (see other definition).
* You must complete a Declaration of Common-Law Relationship form. You may obtain this form from the Human Resources website at www.ryerson.ca/working. For some benefits, the government determines that the Ryerson-paid premiums count as income for tax purposes. Such a benefit is called a taxable benefit because you must pay tax based on this assessed value. For example, tuition waiver and premiums for group life insurance are taxable benefits. Under the Long-Term Disability Plan, you are considered to be totally disabled (to have a total disability) for the first 36 months of benefits for RFA, or for the first 24 months of benefits for non RFA, if you are unable to perform the duties of your own occupation. After this 36-month or 24-month period, you are totally disabled if you cannot engage in any occupation for which you are reasonably suited by education, training, or experience. Coverage in the event of accidental death or dismemberment while travelling on Ryerson business. The benefit is four times your basic salary to a maximum of $500,000. Ryerson pays 100% of the premium. This plan provides coverage for international residents or Canadian residents (and their dependents) who have been out of Canada for more than six months and are hired to work in Ontario and who are not eligible for OHIP. Ryerson, along with 11 other Ontario Universities has joined to together for the purpose of pooling or sharing the risk for the life insurance plans. More members spread the risk.

RFA Dental Plan Details

Overview

Undoubtedly, you will have to visit the dentist from time to time – to maintain healthy teeth.
The Ryerson Dental Plan pays 100% of many eligible routine dental expenses, 65% of major restorative services, and 50% of orthodontic services. As well, there are no employee-paid premiums for this Plan – Ryerson pays for your coverage.
If you have dependents, they are also covered under the Plan if you choose family coverage and you provide the required enrollment information.
Be aware that some expenses have limits and some are not eligible. This site describes limits on covered expenses and lists excluded expenses. To find out if a specific service or item is covered, you can also visit Sun Life’s website or call 1-800-361-6212.

Costs & Tax Facts

What is the cost for the Dental Plan?

There are no employee-paid premiums. Ryerson pays for the coverage for you and your dependents.
However, some expenses are not covered by the Plan or are covered only up to a maximum reimbursement limit. See Specifics of Coverage for information about individual limits, and Excluded Expenses for a list of ineligible expenses.

How do taxes apply to the Dental Plan?

This coverage does not result in a taxable benefit for income tax purposes.

Covered Expenses

Is there an upper limit to my reimbursement under the Dental Plan?

The Plan covers eligible expenses up to an unlimited overall lifetime maximum.
However, some eligible expenses are subject to maximums or limitations. See Specifics of Coverage for information about individual limits, and Excluded Expenses for a list of ineligible expenses.

Is there a deductible?

There is no deductible under the Dental Plan. The Plan will begin to reimburse either all or a portion of your eligible dental expenses from the first dollar spent.

What coverage does the Dental Plan provide?

The table below describes your Dental Plan coverage. Eligible expenses are reimbursed at the percentage shown, up to the limits stated. When the Plan does not cover an expense at 100%, you will pay for the portion not covered. For example, if you have a claim for an eligible major restorative treatment, the Plan will reimburse you 65% of the total cost up to the Fee Guide maximum. You will pay the remainder of the cost.
As well, some expenses are not covered under the Plan. See Excluded Expenses for a list of ineligible expenses.
If your dentist recommends a treatment or service that is not mentioned, call Sun Life at 1-800-361-6212. They will help you determine if the expense is covered and if it is subject to any restrictions.


Specifics of Coverage
Routine Services: 100% Reimbursement (to limits indicated)

Covered Services	Description of Services	Maximums & Limitations (all reimbursement based on currentdentalfee guide – see below table)
Cleaning	Polishing teeth	Must be separated by at least five months, limited to two per benefit year
Crowns	Prefabricated metal restorations and their repairs	Must not be in conjunction with placement of permanent crowns
Examinations	Complete examinations Recall examinations Emergency or specific examinations	Recall examinations must be separated by at least five months, limited to two per benefit year
Fillings	Covered types: amalgam, silicate, acrylic, composite resin Transitional restoration of fractured anterior teeth Steel crowns on primary teeth Cement
Fluoride	Topical application of fluoride	Must be separated by at least five months, limited to two per benefit year
Gums, treatment of (non-surgical)	Treatment of diseases of the gums and other supporting tissues of the teeth	Occlusal equilibration may not exceed 8 units per year See also Scaling
Pit and fissure sealants		Only reimbursed for persons under age 19
Root canals	Root canal therapy and root canal fillings Treatment of diseases of the pulp tissue, including pulpcapping, pulpotomy, periapical services, and other endodontic procedures Emergency endodontic procedures
Scaling	Scraping teeth to remove tartar	Scaling may not exceed 16 units per year
Surgery, minor	Uncomplicated removals Surgical removals and repositioning Surgical excision or incision Fractures, lacerations, frenectomy, and miscellaneous surgical services	Excludes implants, transplants, and repositioning of the jaw
Tests and laboratory work	Diagnostic and laboratory services Includes biopsy of oral tissue and pulp vitality tests	See "About the Dental Fee Guide" below this table for limitations on laboratory charges
X-rays	X-rays to diagnose a symptom or examine progress of a particular course of treatment, including: full-mouth, bitewing, periapical, occlusal, or extra oral X-rays; sialography; fistulography; cystography; and tomography Radiopaque dyes to demonstrate lesions Interpretation of X-rays received from another source	Full-mouth X-rays (panographic or panoramic) once in any 24-month period Bitewing X-rays every five months, limited to two per benefit year Periapical X-rays limited to one complete series every 24 months
Other services	Anaesthesia related to any routine services Antibiotic drug injections by the attending dentist Consultations that are required with another dentist Dentures: Rebasing or relining of an existing partial or complete denture Emergency or pain relief services Extractions (removal of teeth) House calls, institutional calls, and office visits Space maintainers (provision of)

Major Restorative Services: 65% Reimbursement (to limits indicated)

Covered Services	Description of Services	Maximums & Limitations (all reimbursement based on currentdentalfee guide – see below table)
Bridges	Bridge pontics, retainers, abutments, and other prosthetic services Construction and insertion and repairs	The fee for a replacement bridge is not an eligible expense during the five-year period following the construction or insertion of a previous bridge, unless it is needed to replace one which has caused temporomandibular joint disturbances (TMJ), and which cannot be economically modified to correct the condition
Crowns	Crowns and their repairs	Does not include prefabricated metal restorations (covered under Routine)
Dental Implants	Construction and insertion of implants to replace a tooth or teeth	Coverage is limited to a maximum eligible expense of the value and quality of the appropriate denture (where a complete denture is the only alternative treatment) or bridge, which would have been placed had implants not been selected A treatment plan and a request for pre-determination must be submitted to Sun Life prior to the commencement of treatment or the claim will be denied Payment will be approved up to the maximum of the appropriate alternative treatment procedure Coverage is limited to teeth extracted while the member is covered under the Ryerson plan, or in the case where some type of appliance is replacing the missing teeth, the appliance must be greater than five years old
Dentures, standard	Complete dentures, partial dentures, and partial denture additions Construction and insertion and repairs	The fee for a replacement standard denture is not an eligible expense during the five-year period following the construction or insertion of a previous standard denture, unless one of the following situations occurs: it is needed to replace one which has caused temporomandibular joint disturbances (TMJ), and which cannot be economically modified to correct the condition, or it is needed to replace a transitional denture which was inserted shortly following extraction of teeth and which cannot be economically modified to the final shape required
Gums, surgical procedures for	Surgical services Post-surgical treatment Adjunctive procedures Post-treatment evaluation
Inlays and onlays	Metal or porcelain restorations
Surgery, major	Surgical services and related anaesthesia	Excludes removal of impacted teeth (covered under Routine), implants, transplants, or repositioning of the jaw

Orthodontic Services: 50% Reimbursement (to limits indicated)

Covered Services	Description of Services	Maximums & Limitations (all reimbursement based on current dental fee guide – see below table)
Interceptive, interventive, or preventive orthodontic services	Oral examinations Skull and facial bone surveys Cephalometric radiographs Diagnostic casts Surgical services Observation, adjustments Removable or fixed appliances, repairs, and alterations Active appliances for tooth guidance or uncomplicated tooth movement Retention appliances	Does not include space maintainers (covered under Routine)
Comprehensive orthodontic treatment	Treatment utilizing removable or fixed appliances, or a combination of both Includes diagnostic procedures, formal treatment, and retention

Out-of-country coverage
The plan will reimburse your expenses up to the amount that would have been paid if the work had been done in Ontario. The procedures and associated costs must also be considered reasonable and customary in the area in which the service was performed.
If the dentist charges more than the fee that would have been paid if you had incurred the expense in Ontario, then you will be responsible for paying the excess.

About the Dental Fee Guide
The current Ontario Dental Association (ODA) fee guide is used to determine the maximum that the Plan will pay for eachdentalservice. If your dentist chooses to charge more than the ODA fee guide, the portion of the cost above the recommended fee will not be reimbursed under the Dental Plan. Laboratory charges are limited to 66 2/3% of the procedure fee in the ODA fee guide.

Treatments Over $200
If you expect adentaltreatment to cost $200 or more, the insurer will review the expense in advance. This will help you find out how much the Dental Plan will cover and how much you must pay.
In order to receive an advance review, ask your dentist for a detailed treatment plan – called a “pre-determination”– and then submit it to Sun Life before treatment begins. A pre-determination will identify whether a specific service is covered and clarify the reimbursement percentages and limits that apply. After the treatment is complete, you must submit a regular claim form to obtain reimbursement.

Excluded Expenses

What expenses are not covered by the Dental Plan?

Some expenses have specific maximums as listed under Specifics of Coverage. Note that laboratory charges are limited to 66 2/3% of the procedure fee in the ODA fee guide.
Also, the Plan will not pay any portion of the cost for the following:

• Services or treatments that are paid for or covered by any other employer, government plan, or the plan of any political subdivision or law
• Replacement of a stolen or mislaid prosthetic device, appliance, or space maintainer
• Supplies or services prescribed or recommended before you became insured by the Plan
• Initial dentures and bridgework (including crowns and inlays) to replace a tooth or teeth that were congenitally missing before you became insured by the Plan
• Cosmetic services
• Prosthetic devices which are ordered while covered by the Plan, but installed after your coverage has ended
• Charges for appointments not kept or for completion of claims forms
• Expenses related to services or supplies normally intended for sport or home use (e.g., mouthguards)
• Crowns and onlays placed on an incisor or cuspid tooth that is not functionally impaired
• Expenses resulting from the hostile action of any armed forces, insurrection, or participation in a riot or civil commotion
• Expenses resulting from participation in any military action in the armed forces of any country or established international authority
• Expenses resulting from an attempted or actual criminal offence
• Any expense for which indemnity or compensation is provided under any worker’s compensation act, criminal injuries compensation act or similar legislation
• Expenses resulting from intentional, self-inflicted injury

Making Claims

How should I submit a claim for the Dental Plan?

You must submit claims within 18 months of incurring an expense. It is to your advantage to submit most claims as quickly as possible, but it is helpful if you hold claims fordentalexpenses until they total $50 or more.
If you have a multi-appointment procedure that is not for orthodontic services, you should claim only after the final appointment. You may claim after any orthodontic procedure, whether or not it is part of a series, or after any non-orthodontic procedure that requires only a single appointment.
You may download the Dental Claim Form from either the SunLife or Ryerson HR website or pick up a form from the reception area of Human Resources. Complete the following steps to ensure prompt processing of your claim:

1. Your dentist may submit your dental claim electronically to Sun Life. If this is the case, it is important that you review the form for accuracy of the charges. If the dentist does not electronically file claims, the dentist must complete Part 1 of the claim form and you must complete the remainder of the form (both sides). In addition, indicate whether the reimbursement should be payable to you or to your dentist. If you do not give your dentist a Ryerson claim form, the dentist can use a standard form.
2. The signature at the bottom of the claim form must be yours, whether the claim is for yourself or one of your dependents. The patient (unless a minor) must sign near the top right at "Signature of patient (parent/guardian)." If the claim form is not properly completed, the claim will not be paid.
3. Make a copy of your claim form and receipts for your records. Keep in mind that some dental expenses not reimbursed by your group insurance may be eligible for a tax credit when you file your income tax return.
4. Mail the completed form with all receipts directly to Sun Life. The mailing address is on the back of the claim form.
5. Sun Life will mail a reimbursement cheque, if appropriate, to your home address or to your dentist, depending upon the instructions provided on your claim form. You will also receive an explanation of how your eligibility for payment has been determined. As an alternative, you may contact Sun Life at 1-800-361-6212 to arrange a direct deposit to your bank account.

If you have questions about your coverage or the status of submitted claims, or disagree with any claim settlement, please contact Sun Life at 1-800-361-6212.

How do I submit claims if my spouse has coverage?

The purpose of insurance coverage is to help you meet actual expenses. Ryerson’s benefits have been designed so that benefits paid by all group plans combined will provide coverage up to the actual eligible expenses incurred.
If your spouse is insured under Ryerson’s or another employer’sdentalplan, the Ryerson Dental Plan requires that you follow co-ordination of benefits (COB) procedures when you submit your claims. COB is a set of rules designed to distribute expenses for you and your dependents among plans in a fair manner. The rules set out a specific order for submitting claims depending on who incurred the expense, so that you can obtain maximum reimbursement and so that no more than 100% of the expense is reimbursed.

For you and your spouse:
When an expense is your own, you always submit the claim to the Ryerson Dental Plan first. Your spouse must always submit expenses to his or her plan first.
After the first insurer has processed the claim, you may submit any remaining eligible balance to the second person’s insurer along with a copy of the Explanation of Benefits (EOB) that you received from the first insurer.
If you and your spouse both have coverage with Sun Life, complete section 4 on the claim form, including your spouse’s contract and member ID numbers, and ensure your spouse signs and dates the form. Sun Life will then automatically co-ordinate the claims, which will save you the step of submitting the claim twice to the same insurer.

For your dependent children:
Expenses for children should be submitted first to the plan covering the parent with the earliest birth date in the year and then to the plan insuring the other parent for any remaining eligible balance. For example, if one parent was born in February and the other in August, the parent born in February would submit claims for any eligible childrento his or her plan first. Any remaining eligible balance would be submitted to the plan covering the parent born in August.

To ensure efficient processing of claims, you and your spouse must list each other and your eligible children as dependents under both plans. If you and your spouse both work at Ryerson, you may both have Family Plan coverage.


Ryerson reserves the right, at any time, to amend, change or discontinue any benefit coverage. If there is a question about coverage referred to in any portion of this benefits communication, the master contract from the insurer is the governing document.