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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
- retinal disease
- visual field defects
- corneal disease
- 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
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.
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.