Ontario Health Insurance Plan (OHIP)
A resident of Ontario must have a valid health card to obtain publicly-insured health care services.
OHIP coverage for optometry services
OHIP covers the following eye care services for:
Children 0 to 19 years old: An annual, full comprehensive eye examination plus any follow-up assessments that may be required.
Seniors aged 65 +: An annual, full comprehensive eye examination plus any follow-up assessments that may be required.
Adults aged 20 to 64 years: OHIP does not cover comprehensive eye examinations for this age group. These individuals have private insurance coverage or pay out-of-pocket. Some exceptions to OHIP coverage apply depending on the medical condition. Ask your optometrist if you qualify.
Some optometric services NOT covered by OHIP:
- Additional comprehensive eye exams during the same year of an OHIP-covered exam.
- Eye examinations that are required by potential employers or other third parties.
- Eye examinations required by potential employers or other third parties
- Contact lens fitting exams and progress checks
- Retinal imaging (such as retinal photography, ocular coherence tomography, Heidelberg retinal tomography, etc)
- Laser refractive surgery co-management (pre- and post-operative) visits
- Treatments, such as :
- Contact lenses
- Low vision aids
- Vision Therapy (Eye co-ordination exercises)
- Medications to manage diseases of the eye and surrounding tissues.
Private/Third party insurance
In 2004, the Ontario Ministry of Health and Long-Term Care removed OHIP coverage for regular eye examinations for adult patients between the ages of 20 to 64. Only adult patients with certain medical conditions are covered for annual eye examinations under the Schedule of Benefits for Optometry Services.
The Ontario Association of Optometrists (OAO) promotes the importance of regular comprehensive eye examinations. If your eye examination is not covered by OHIP, check your health insurance company’s benefit plan (i.e., Manulife, Sun Life, Green Shield of Canada, Great West Life) for vision care coverage for eye exams, eyewear, and other optometry services. Many employers have extended health-care benefits for employees. OAO encourages you to contact your insurance carrier for further information.
Optometrists can choose to either directly bill a third party insurance provider or the patient. If a patient pays for an insured service, the third party may reimburse all or part of the fee.
Other publicly-funded optometry programs
Please ensure you provide your coverage information when booking an appointment with your optometrist