The Mystery of OHIP

Eye care coverage is available to many residents in Ontario through the Ontario Health Insurance Plan (OHIP). We will go over the key points so you can get a better understanding of your benefits.

Children’s Eye Coverage:

All children from birth until the age of 19 are covered for a complete comprehensive eye exam every year. Coverage also includes any essential follow up examinations for urgent eye care procedures such as pink eye or a scratch. Parents often ask what should I look for, sometimes its hard to detect vision problems in kids just because they are so adaptable and just don’t know any better. So, bring them in annually for their complete eye exam!

Senior Eye Coverage:

All adults above the age of 65 are entitled to a comprehensive eye exam annually in Ontario. Risk for many eye conditions increases with age. Prevention is key! Through regular eye exams, we can catch early problems and treat them before they become sight threatening. OHIP covers follow up urgent eye exams that maybe needed.

Adult Eye Coverage:

Adults between 20 and 64, are not covered for annual eye exams. However, many people receive insurance coverage through their employers or through private insurance. To make the process easier, we will submit claims to most insurance carriers.

However, some people who have medical conditions that are known to affect the eyes are covered through OHIP: glaucoma, disease of the retina, iritis, diabetes, corneal abrasions, etc. Additionally, if your family doctor or specialist recommends an eye exam for a specific reason, it may be covered through OHIP.

Coverage Beyond OHIP:

OHIP only covers your annual eye exam. Occasionally, there are services not covered through OHIP including the digital eye exam, eye glasses, and contact lenses. Many people have coverage for these services through their employers or private insurance. We will try to help you through the claims process. Remember save all your receipts for eye care expenses, as you can claim them on your income statements (talk to your accountant or tax person for more information).

Preventative eye care is key, whether providing your children with the best vision to excel at school or to detecting sight threatening conditions early on, an annual complete eye exam is key.