Changes to OHIP Coverage for Eye Care Services
Effective November 1, 2004
Routine eye examinations provided by either an optometrist or physician, for patients aged 20 to 64 are no longer covered by OHIP. These individuals pay for this service or have the cost of examinations covered by private insurance.
Eye Care Services Covered
- Changes do not affect seniors or those under age 20. People 65 years and older and under 20 will continue to have OHIP coverage for an eye examination once every 12 months
- Changes do not affect ophthalmology services for patients of any age with medical conditions or diseases affecting the eyes
- Persons receiving assistance under the Ontario Disability Support Program, Ontario Works or the Family Benefits Program continue to receive coverage for routine eye examinations once every two years
Increased Coverage for People with Medical Conditions
OHIP is increasing coverage for patients aged 20 to 64 years with medical conditions affecting the eye. Patients can receive a regular eye examination once every 12 months. Prior to November 1, 2004, eye examinations were covered once every two years.
Patients 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.
Patients aged 20 to 64 who have conditions not listed above may also be covered for a regular eye examination. They should discuss this with their primary health care provider.