Learn What Eye Services Are Covered Under

OHIP Insurance Coverage

Learn more about what OHIP insurance coverage is available for optometric services, and how your third-party insurance works for comprehensive eye care.

In Ontario, all residents are covered for publicly-insured health care services under OHIP with a valid Ontario health card. However, OHIP insurance coverage does not cover all of the services you may need, and is limited in coverage for optometric services. You may have some questions about whether you or your family are covered for eye exams, and we are happy to provide you with the answers you need.

OHIP insurance coverage applies to some optometric services depending on your age and your medical situation. Learn more about OHIP and third-party medical insurance coverage as it relates to eye care, and how our optometrists work with your insurance to provide you with the best possible services.

What Eye Services Does OHIP Cover?

Yearly eye exams are covered under OHIP for children under age 19 and for senior adults over the age of 65. This coverage also includes any follow-up assessments that may be required as a result of those yearly examinations. Therefore, your children will be covered for any yearly assessments they may need and you will not need to pay out of pocket for these exams.

Additionally, some medical conditions that have a substantial impact on the eye may also be covered by OHIP. Our optometrists are highly knowledgeable and are more than happy to discuss any potential exceptions with you.

Optometric Services Not Covered Under OHIP

Adults ages 20 to 64 are not covered for annual eye examinations and will need to pay for these services out of pocket if they are not covered by private or third-party health insurance. However, some individuals in this age range may qualify for an exception under OHIP if optometric services are determined to be medically necessary. These conditions may include glaucoma, cataracts, retinal disease, and diabetes mellitus, among others. Again, it’s best to discuss this with your optometrist for more information on your specific circumstances.

The following types of optometric services are not covered under OHIP:

  • Any additional comprehensive eye exams outside of the annual exam
  • Treatments for eye conditions (such as vision aids, artificial tears, etc.)
  • Regular monitoring and follow-up assessments if not deemed medically necessary by a doctor
  • Eyeglasses or contact lenses, as well as any progress checks necessary
  • Retinal imaging
  • Additional medications required
  • LASIK, PRK, or refractive treatments and co-management services (such as pre- and post-op assessments)

Private or Third-Party Health Insurance Coverage

Third-party health insurance coverage is offered in the workplace depending on the employer’s discretion. Some companies also offer optional extended health care coverage that you may choose to pay into. These benefit policies may cover comprehensive eye exams, glasses or contact lenses, or other services provided by an optometrist.

To determine if your insurance coverage offers vision care benefits, consult with your third-party health insurance company. This information is often readily available in the benefits package you may have received, or within your company policy documents.

Get In Touch With Us

For More Information on OHIP Coverage

At Fervaha Eye Care, our caring and compassionate optometrists understand your concerns when it comes to OHIP coverage and health care costs. For this reason we will work with your coverage, whether this is through OHIP or your private health insurance company.

Get in touch with us to book your appointment and talk to one of our knowledgeable optometrists. We’re available to answer any questions you may have and talk you through how our eye care assessments, evaluations, and examinations work. Book an appointment now and we’ll help you get sorted.