OHIP & Eye Care

Many patients are curious as to what eye care costs their Ontario Health Insurance Plan (OHIP) will cover. To reduce confusion, we cover the basic guidelines for OHIP and eye care costs below.

In 2004, the Ontario government made changes to the health care coverage for eye examinations for all Ontario residents. The biggest amendment was that OHIP no longer covers eye exams for patients 20 to 64 years of age. Patients of this age range now rely on their private insurance plans to fund their exam costs.

Children up to the age of 19 and seniors after the age of 65 will have an eye exam covered by OHIP once every 12 months. These age groups are susceptible to eye conditions that may negatively affect quality of life. With consideration of children’s rapid developmental change, it is essential that they get yearly eye exams to avoid falling behind their peers.

There is one other exception to the change in OHIP’s coverage policy for eye care. OHIP will cover a yearly eye exam for patients who are 20 to 64 who have certain medical conditions that affect the eye. Patients with the following eye conditions are covered by OHIP:

    • Diabetes
    • Glaucoma
    • Cataract
    • Retinal disease
    • Amblyopia
    • Visual field defects
    • Corneal disease
    • Strabismus

Patients who do not have the above conditions may still be covered by OHIP for an exam, but would need to consult their primary care provider and have a valid ‘request for eye examination requisition’. Patients who are hoping to have their optometry visit covered must present their health card at the time of their visit. At 360 Eyecare – Metro, you may use either the red and white health card or the newer photo health card. However, some optometry offices may only accept the latter.

For Canadian newcomers, OHIP coverage normally becomes effective 3 months after residency is established in Ontario. To gain access to an OHIP card, you will need to visit a government licensing office to have your photo taken and to fill out documentation that establishes your eligibility for coverage.

If you have any further questions about OHIP and your eye care, contact our optometry office in downtown Toronto.