OHIP Covered Examinations

In 2004, routine eye examinations provided by either an optometrist or a physician, for patients aged 20 to 64 years of age, were no longer covered by the Ontario Health Insurance Plan (OHIP).

Children 19 years of age and under are still covered for routine vision examinations, once a year (plus a day). They are also covered for some minor vision examinations to monitor specific conditions such as a weaker eye or a turned eye.

Seniors, 65 years of age and over are also covered for a routine vision examination, once a year (plus a day). Some minor vision assessments are also covered, such as monitoring a cataract, macular degeneration or glaucoma. Not all components of the eye examinations are covered, such as retinal photography or ocular coherence tomography (OCT). Also, certain types of exams are not covered, such as a Ministry of Transportation (driver’s exam) examination.

OHIP does not typically cover eye tests or examinations for those individuals between 20 and 64 years of age.

Certain specific eye and general health conditions, for those between the ages of 20 and 64, are still covered under OHIP. These individuals are covered, for a routine vision examination, once a year (plus a day). They are also covered for minor vision examinations, only specific to their primary eye/health condition. Please contact our office to see if your eye condition or general health condition is covered. On occasion, the doctor may need to examine you to determine whether or not you are eligible for OHIP coverage. The government guidelines are such that the patient must have the condition, and is not simply at risk for that condition (i.e. if your parents have glaucoma and you have high eye pressure, but do not actually have glaucoma – then you are NOT covered).

Always bring your valid health card to every appointment to our office or to any specialist’s office, which we may refer you to.

*Please feel free to contact our office if you have any questions concerning your eligibility for OHIP.

For further information, please review the Ontario Ministry of Health and Longterm Care website (http://www.health.gov.on.ca/en) .