POLICIES

PHIPA Privacy & Security 

We possess private, confidential information about patients, their health and their care, including the electronic medical record. Ontario’s Personal Health Information Protection Act (PHIPA) was established in 2004 andprovides a set of rules for the collection, use and disclosure of personal health information. We adhere to all policies and procedures outlined in PHIPA so that you can trust that your information is kept confidential. Click here for more information.

OHIP Coverage For Optometry Services

OHIP covers the cost of one annual comprehensive eye examination plus any follow-up assessments that may be required for:

  • Children 0 to 19 years old
  • Seniors aged 65+

For adults aged 20 to 64 years, OHIP does not cover comprehensive eye examinations unless you have a specific condition affecting the eyes that requires regular monitoring. OHIP covers one annual comprehensive eye examination and any related follow-up appointments related to the condition. Covered conditions are:

  • diabetes mellitus
  • glaucoma
  • cataract
  • retinal disease
  • amblyopia
  • visual field defects
  • corneal disease
  • strabismus
  • recurrent uveitis
  • optic pathway disease

Individuals aged 20 to 64 without one of the covered conditions must pay out of pocket or through third party insurance.

Third Party Insurance

You may have coverage for optometric fees through your private insurance provider. We kindly encourage you to check your coverage ahead of time and bring your insurance information to your appointment . The majority of private and corporate insurance plans for eye care involve a maximum claimable amount for optometric services biannually.We direct bill to the following providers:

  • Sun Life Financial
  • The Cooperators
  • Green Shield Canada
  • Manulife
  • Johnson
  • CanadaLife

Other Programs

Other government programs, such as Ontario Works, ODSP, First Nations and Inuit Health, Blue Cross and Veteran’s Affairs, also provide optometric coverage for eye examinations. Please speak with your worker or representative if you are eligible for benefits under one of these programs.

Retinal Imaging

Certain services are not covered by OHIP, regardless of age. This includes retinal imaging: taking a high-definition photograph of the back of the eye, the retina.  Retinal imaging is a useful tool for ocular health screening, monitoring disease progression and often aids in the early diagnosis of eye conditions. Dr. Smart and the College of Optometrists of Ontario highly encourage you to take advantage of this technology. However, retinal imaging cannot be made a condition of you accessing an OHIP insured eye examination and our office fully complies with that policy.