Eye Exam Guide
OHIP Coverage for Eye Care Services
Eye Care Services Not Covered:
Routine eye examinations provided by either an optometrist or physician, for patients aged 20 to 64, are not covered by OHIP. These individuals are responsible for payment for these examinations or have the cost covered by private insurance.
However, under the Ministry of Community and Social Services (MCSS), persons receiving assistance through the Ontario Disability Support Program, Ontario Works, or the Family Benefits Program will receive coverage for routine eye examinations once every two years. If you have any questions about the coverage provided under these programs, please call Client Services at MCSS at 1 888 789-4199 (toll free) or 416 325-5666 (Toronto) or 1 800 387-5559 (TTY).
Eye Care Services Covered:
- People 65 years and older and those younger than 20, are covered by OHIP for a routine eye examination provided by either an optometrist or physician once every 12 months plus any follow-up assessments that may be required.
- Specified ophthalmology services for patients of any age with specified medical conditions or diseases affecting the eyes are insured.
- Insured persons aged 20 to 64 years with specified medical conditions affecting the eye can receive an OHIP insured regular eye examination once every 12 months.
- Insured persons aged 20 to 64 with any of the following conditions can go directly to their optometrist or physician to receive an OHIP insured eye examination: diabetes mellitus, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent uveitis or optic pathway disease.
- Insured persons aged 20 to 64 who have certain medical conditions not listed above may also be covered for regular eye examinations. They should discuss this with their primary health care provider.
For more information please visit the website for Ontario Health.
Social Assistance/ODSP Coverage for Eye Care Services
If you are receiving Ontario Disability Support Program Income Support, and do not have vision care coverage
- under the Ontario Health Insurance Plan (OHIP), or
- through a private insurance plan
you and your family may be able to get help with vision care costs.
What OHIP covers
- annual eye examinations for patients under 20 years of age and patients 65 years of age or older
- major eye examinations for all patients with medical conditions that affect the eye such as infections or diseases.
What the Ontario Disability Support Program covers:
The Ontario Disability Support Program Vision Care Benefit provides:
- routine eye examinations (once every two years) for you and your family if coverage under OHIP is not available
- assistance with the cost of prescription eyeglasses (once every three years) for you, your spouse and your children under 18 years of age
- assistance with the cost of eyeglass repairs for you, your spouse and your children 18 years of age.
Children 18 years of age or older may be able to get help with the cost of prescription eyeglasses and eyeglass repairs through Ontario Works discretionary benefits.
How do I get the Vision Care benefit?
To get assistance with the cost of prescription eyeglasses:
- contact your local Ontario Disability Support Program office and ask for a Vision Care benefit authorization form
- take this form to your optometrist or optician and ask them to fill it in when you get glasses, frames or repairs. You will need to sign the form at that time.
The optometrist or optician will send your completed form to the Ministry of Health and Long-Term Care to get their reimbursement. You do not need to pay for your eyeglasses up front.
The Vision Care benefit covers prescription eyeglasses up to a maximum amount. If you choose to get more expensive lenses or frames, you will need to pay the difference directly to the optometrist or optician.
When you have an eye examination with your optometrist or physician, you should present both your:
- Ministry of Community and Social Services drug card, and
- Health (OHIP) card
For more information, please visit this site.
Are you looking to get your eyes checked? Schedule an eye examination with an Ocuwear Optometrist.