Eye Care Coverage in Ontario: Explained

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Blog by Envision Eye Care

Ontario’s Health Insurance Plan (OHIP) provides eye care coverage for many people in the province, but the rules and details of it are a mystery to most.

Here, we share some key points you need to know when it comes to eye exams, costs and eye care coverage for all Ontarians. This includes children, adults, and seniors so you can get all the eye care benefits you and your family are entitled to.

Children’s eye care coverage

All children from birth to age 19 are covered for a complete eye exam once per year, along with any follow-up exams recommended by their eye doctor for any ocular medical conditions they may have. For children, early detection and proactive eye care is important so don’t miss these annually covered exams.

Adult eye care coverage

If you’re an adult who is older than 19 years, but younger than 65 years of age, you are probably not covered for annual eye exams to check your vision (e.g. for the purposes of prescribing eye glasses or contact lenses). You also will not be reimbursed if you wish to get a second opinion, or need pre- or post-op care for elective laser refractive surgery. Finally, treatments such as eye glasses, contact lenses, eye medication, and low vision tools are not on the list of benefits either.

However, if you have certain medical conditions that are known to affect the eyes, you will be covered for annual exams, plus any required follow-up care. Covered conditions are as follows: cataracts, diseases of the retina, glaucoma, type I and II diabetes, disease of the optic pathway, amblyopia, recurring uveitis, diseases of the cornea, and strabismus. Exams for conditions not on this list may be covered if your doctor has a specific reason to recommend them and requests approval.

These lists of what’s covered are not complete, so if you ever run into an eye issue that requires care but are worried about who will pay for it, contact your eye care professional and ask – you may be pleasantly surprised by the answer and it never hurts to check.

Seniors eye care coverage

Just as with children, seniors who are 65 years of age or older are covered for an annual eye exam, plus any required follow-up care.

How to get the OHIP eye care coverage you’re entitled to

In order to have your eye care provider direct bill OHIP for covered treatments and services, you’ll need to be an Ontario resident with a valid health card to show as proof that you’re entitled to benefits. If you’re out of province when you obtain care for covered items, you’ll likely have to pay them directly, then save your receipts to submit to the Ontario Ministry of Health for reimbursement of eligible expenses.

Coverage beyond OHIP

Many people have eye care coverage through their employers or private insurance that can help cover all or part of the cost of services and treatments that OHIP doesn’t pay for. Whether you pay for all or part of the cost, save all receipts for eye care treatments and appointments that you pay for out of pocket since many of them can be used to reduce your income taxes owing at tax time (ask your tax preparer for details on the rules).

Prevention is key, so be proactive about caring for your eyes

Seeing your eye care professional regularly is just as important as your regular doctor or dentist visits. They can catch small problems early before they turn into large ones, and help you to keep your eyes as healthy as possible by treating any conditions you already have, and helping you to prevent new ones from cropping up. Talk to your eye doctor today about setting up your next appointment – it’s any easy step to take to preserve your precious sight!

“I’m looking for an eye exam centre near me!” If you’re in the Oakville, Burlington ON area and it’s time for an eye exam, visit the optometrists at Oakville’s Envision Eye Care today!