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Full-time or LTF

Benefits

Dental plan covered expenses, limits and exclusions

What coverage does the Dental Plan provide?

Your Dental Plan coverage is described below. Eligible expenses are reimbursed at the percentage shown, up to the limits stated based on reasonable and customary amounts suggested in the current Ontario General Practitioner Dental Fee Guide.

When the plan does not cover an expense at 100%, employees are responsible to 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 Ontario General Practitioner Dental Fee Guide maximum. You will pay the remainder of the cost.

If an expense is not eligible under the Dental Plan, you are responsible for its cost. 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.

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

The plan covers eligible expenses up to an unlimited overall lifetime maximum, but some eligible expenses are subject to maximums or limitations. 

Please note that each eligible expense is allocated to the benefit year in which it is incurred. The benefit year runs from January 1 to December 31 each year. 

Specifics of coverage

Preventative, restorative and surgical services

The services below are considered "preventative, restorative and surgical services” and are eligible for 100% reimbursement to the limits indicated. All reimbursement is based on the current Ontario General Practitioner Dental Fee Guide.

Cleaning

Description of services

  • polishing teeth

Maximums and limitations

  • must be separated by at least five months, limited to two per benefit year
Endodontic root canals

Description of services

  • 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
Fillings

Description of services

  • covered types: amalgam, silicate, acrylic, composite resin
  • transitional restoration of fractured anterior teeth
  • steel crowns on primary teeth
  • cement
Fluoride and polishing

Description of services

  • topical application of fluoride
  • polishing

Maximums and limitations

  • must be separated by at least five months, limited to two per benefit year
Non-surgical periodontic procedures

Description of services

  • treatment of diseases of the gums and other supporting tissues of the teeth

Maximums and limitations

  • occlusal equilibration may not exceed 8 units per year
  • see also Scaling
Oral examinations

Description of services

  • complete examinations
  • recall examinations
  • emergency or specific examinations

Maximums and limitations

  • recall examinations must be separated by at least five months, limited to two per benefit year
Pit and fissure sealants

Maximums and limitations

  • only reimbursed for persons under age 19
Scaling

Description of services

  • scraping teeth to remove tartar

Maximums and limitations

  • scaling may not exceed 16 units per year
Surgery, minor

Description of services

  • uncomplicated removals
  • surgical removals and repositioning
  • surgical excision or incision
  • fractures, lacerations, frenectomy, and miscellaneous surgical services

Maximums and limitations

  • excludes implants, transplants, and repositioning of the jaw
Tests and laboratory work

Description of services

  • diagnostic and laboratory services
  • includes biopsy of oral tissue and pulp vitality tests

Maximums and limitations

X-rays

Description of services

  • 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; tomography; and panoramic
  • radiopaque dyes to demonstrate lesions 
  • interpretation of X-rays received from another source

Maximums and limitations

  • 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

Description of services/Maximums and limitations

  • 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 and related anaesthesia)
  • house calls, institutional calls, and office visits
  • prefabricated metal restorations and repair, other than in conjunction with the placement of permanent crowns
  • space maintainers (provision of)
Major restorative services

The services below are considered "prosthodontic procedures" and are eligible for 65% reimbursement, up to the limits indicated. All reimbursement is based on the current Ontario General Practitioner Dental Fee Guide.

Bridges

Description of services

  • bridge pontics, retainers, abutments, and other prosthetic services
  • construction and insertion and repairs

Maximums and limitations

  • 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

Description of services

  • crowns and their repairs

Maximums and limitations

  • does not include prefabricated metal restorations (covered under Routine Services)
Dental implants

Description of services

  • construction and insertion of implants to replace a tooth or teeth

Maximums and limitations

  • expenses will be reimbursed at either 65% of the alternative conventional treatment (e.g. bridge or denture) or 50% of the implant cost, whichever is higher, subject to the general practitioners dental fee guide)
  • a treatment plan and a request for pre-determination for both the conventional method (bridge or dentures) and the complete dental implant procedures (bone grafts if necessary, implant post, final prosthesis, additional materials, etc). must be submitted to Sun Life prior to the commencement of treatment or the claim will be denied
  • if some type of appliance is already replacing missing teeth, coverage for dental implants will only be eligible if the appliance is greater than 5 years old
  • payment is limited to the current Ontario general practitioner's fee guide
  • fees for specialists are limited to 120% of the current Ontario general practitioner's guide
Dentures, standard

Description of services

  • complete dentures, partial dentures, and partial denture additions
  • construction and insertion and repairs

Maximums and limitations

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
Inlays and onlays

Description of services

  • metal or porcelain restorations
Surgery, major

Description of services

  • surgical services and related anaesthesia

Maximums and limitations

  • excludes removal of impacted teeth (covered under Routine Services), implants, transplants, or repositioning of the jaw
Surgical periodontic procedures

Description of services

  • surgical services
  • post-surgical treatment
  • adjunctive procedures
  • post-treatment evaluation
Orthodontic procedures

The services below are considered “orthodontic procedures” and are eligible for up to 50% reimbursement to the limits indicated. All reimbursement is based on the current Ontario General Practitioner Dental Fee Guide.

Interceptive, interventive, or preventive orthodontic services

Description of 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

Maximums and limitations

  • does not include space maintainers (covered under Routine Services)
Comprehensive orthodontic treatment

Description of services

  • treatment utilizing removable or fixed appliances, or a combination of both
  • includes diagnostic procedures, formal treatment, and retention
Dental implants

Dental implants are included in the dental plan as an alternative to conventional dental procedures for a missing tooth/teeth. The conventional methods are a bridge or dentures.

What coverage is available?

There are two methods that will be used to determine how much will be reimbursed. The fast method will reimburse up to 65% of what the conventional method (bridge or denture) would have cost. The second method will reimburse 50% of the impact costs. You will be eligible for reimbursement up to the higher of the two methods. 

Who is covered for dental implants?

Eligible plan members and their dependents requiring major restorative dental treatment. 

What is the procedure for getting implants covered?
  • A pre-determination (estimate) must be submitted to Sun Life for both the conventional method (bridge or denture) and the complete dental impact procedure (bone grafts if necessary, implant post, final prosthesis, additional materials, etc.) Failure to provide both estimates or if estimates are incomplete will delay the start of the treatment plan. 
  • Sun Life will advise the plan member of the dollar amount that will be reimbursed prior to the person deciding upon a procedure.
  • Payment will be limited to the predetermination amount stated.
The plan member is responsible for:
  • arranging for the dental practitioner to prepare a pre-determination (estimate) for both the conventional method (bridge or dental) and the complete implant procedure
  • deciding upon the course of treatment in consultation with the dental practitioner
Sun Life is responsible for:
  • will review both estimates and determine which costs more; the bridge denture or dental implants and will advise the member in writing
  • liaising with the dental practitioner/plan member in the event clarification of the treatment plan is required
  • paying the claim based on the more expensive option
The university is responsible for:
  • adjudicating in the matters of disputes
Limitations
  • coverage is limited to teeth extracted while the member is covered under the Ryerson Dental plan or in the case where the member already has some type of appliance replacing the missing teeth, the appliance must be greater than five years old
  • payment for implants will not be approved for cosmetic purposes. If there are no natural teeth missing then an implant or any type of replacement is not an eligible expense
  • charges for replacement implants are not an eligible expense during a 5-year period following the construction/insertion of the initial appliance
  • reimbursement is limited to the current annual Ontario general practitioners dental fee guide
    • fees for specialists are limited to 120% of the Ontario general practitioners fee guide
  • failure to submit the pre-determination will result in the claim being denied    
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 the expense was occurred in Ontario, then employees are responsible for paying the excess.

About the Dental Fee Guide

The current Ontario Dental Association (ODA) General Practitioner Fee Guide is used to determine the maximum that the Plan will pay for each dental service.

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. If dental services are performed by a dental specialist, the maximum reimbursement will be 120% of the general practitioners fee guide. 

Laboratory charges are limited to 66⅔% of the procedure fee in the ODA fee guide.

Treatments over $200

If you expect a dental treatment to cost $200 or more, SunLife will review the expense in advance. This way you can find out how much the Dental Plan will cover and how much you will be responsible for paying.

How do I receive an advanced review of expenses?

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. Alternatively, your dentist can submit the pre-determination electronically to Sun Life. 

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.

For help completing a pre-determination visit Sun Life’s website or call Sun Life at 1-800-361-6212.

Excluded expenses

What expenses are not covered by the Dental Plan?

Some expenses have specific maximums as listed under Specifics of Coverage.

Laboratory charges are limited to 66⅔% of the procedure fee in the ODA fee guide.

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., mouth guards)
  • crowns and inlays 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

For more information contact Sun Life at 1-800-361-6212.


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.