OHIP Coverage & Insurance
Do I have to pay for my eye exam?
As of November 1st, 2004, routine eye examinations provided by either an optometrist or ophthalmologist, for patients aged 20 to 64 are no longer covered by OHIP. Patients 65 years and older and under 20 will continue to have OHIP coverage for an eye examination once every 12 months. Please remember to bring your valid OHIP card every time.
Covered by OHIP:
- Infants, children and teens 0-19 years of age
- Seniors over 65+ years of age
- Adults with Medical Conditions
(Diabetes, Glaucoma, Cataract, Macular Degeneration,
Amblyopia, Strabismus, Keratoconus, Retinal Disease,
Corneal Disease, Optic Nerve Disease, Uveitis, Grave's
- ODSP & Ontario Works MCSS - covered (see below)
**OHIP does not cover glasses or contact lenses for any age group**
Patients maybe covered by their own insurance plans. You may contact your Benefits Provider to inquire whether coverage includes the eye exam or glasses/contact lens, or both . Below are some frequently used plans:
Blue Cross: 1-800-234-8881 or (416) 626-1688
Great West Life: 1-800-461-6090 or 1-800-665-2648
Green Shield: 1-888-711-1119
ManuLife and Maritime Life: 1-800-268-6195 Sun Life: 1-800-361-6212 or 1-800-361-2128 X2693
For routine eye exams, a referral to see our optometrist is not required. You can simply call our office to book an appointment. Your family doctor may request an eye exam if there is a medical diagnosis (Diabetes, Stroke, or Shingles) or certain medications that may affect your eyes and/or vision.
To see an ophthalmologist, a referral is required either from an optometrist or your family doctor.
Ocular Health Visit / Problem
0-19 years of age: OHIP covered - all visits
20-64 years of age: not covered by OHIP, unless it's a major eye disease
65+ years of age: OHIP covered - all visits
ODSP: OHIP covered- all visits
*The Ministry of Community and Social Services (MCSS) also provides coverage to those who qualify.
Routine Exam: Vision & Ocular Health
0-19 years of age: covered by OHIP - 1 every 12 months
20-64 years of age: Not covered by OHIP
65+ years of age: covered by OHIP - 1 every 12 months
* may require referral from family doctor
ODSP: covered by OHIP - 1 every 12 months
Getting an Appointment
Recipients of income assistance are eligible for coverage for a routine eye exam. You must obtain prior approval from your social worker along with an authorization form. In most cases, you will have 30 days to be seen by the optometrist. Recipients and their spouse and dependent children are covered once every 24 months for eye exams.
MCSS also provides coverage for glasses, but the benefits may vary with ODSP and OW. Please check with your case worker to see how often you are eligible to get new glasses