DOES OHIP COVER EYE EXAMS
OHIP COVERAGE FOR OPTOMETRY SERVICES
OHIP covers the following service for:
• Children who are under the age of 19: A complete annual eye examination in addition to following up on the assessment that is needed.
• Seniors above the age of 65: A complete annual eye examination performed annually for the age group in addition to any follow-up assessment that is needed.
Adults between the age of 20 – 64: There is no thorough eye exam for the age group. They have the option of accessing private eye care or personal insurance eye treatment. Although it’s subject to some exceptions depending on the medical condition of the person. Consult your optometrist to see if you are qualified. The cover conditions are:
• Retina disease
• Visual field defects
• Corneal disease
• Optic pathway disease
• Recurrent uveitis
Here are some of the optometric services that OHIP does not cover:
• An additional full eye exam in the same year with an OHIP-covered exam.
• Eye examinations that are deemed compulsory by potential employers and third parties.
• Fitting exams for content lenses and progress check.
• Retina imaging like ocular coherence, tomography, retinal photography, Heidelberg retina tomography, etc.
• Laser refractive surgery-management (pre and postoperative) visits.
• Contact lenses
• Low vision aids
• Vision therapy (eye coordination exercises)
• Medications to apply to surrounding tissues and diseases of the eye.
PRIVATE THIRD-PARTY INSURANCE
Regular eye checks up was excluded by the Ontario Ministry of Health and Long-Term care for adults’ patients of age 20-64 years old. The annual eye exam covers only adults with some specific medical problems under the Benefits for Optometry services schedule.
The significance of a regular eye examination is endorsed and promoted by the Ontario Association of Optometrists. You should check your health insurance company’s benefit plan (Sun Life, Manulife, Green Shield of Canada, Great-West Life) in case OHIP does not cover your eye exam for vision care coverage for eyewear, eye exams, and other optometric services. Some employers have extended health care benefits for employees. You are advised to contact your insurance carrier for further details.
An optometrist has the option of choosing if they should bill a third-party insurance provider directly or bill the patient. A third party might be entitled to reimbursement if the third party had already paid for an insured service.
Always Confirm What Coverage OHIP will and will not cover by visiting the Ontario Government website.