Ontario Health Insurance Plan (OHIP) Coverage
OHIP Coverage for Eye Examinations
OHIP provides coverage for eye care services for the following general population:
Children aged 0 to 19 years: An annual, full eye examination.
Seniors aged 65 and above: An annual, full eye examination.
Adults aged 20 to 64 years: Eye examinations for adults 20 to 64 years of age are not covered by OHIP. There are some exceptions for certain medical conditions. It is recommended that you discuss coverage details with your Doctor of Optometry who will be able to evaluate and comment on your specific needs and coverage levels in detail.
Optometric Services NOT Covered by OHIP include, but are not limited to:
- Additional eye examinations or second opinions.
- Eye examinations that are required by potential employers or other third parties.
- Contact lens progress checks.
- Laser refractive surgery management (pre- and post-operative) visits.
- Recommended treatments such as eyeglasses, contact lenses, low vision aids, eye co-ordination exercises and eye medications.
Although OHIP provides good coverage in most cases, there are aspects of eye health and vision care that are not covered under OHIP.
A resident of Ontario must have a valid health card to show that he or she is entitled to health-care services paid for by OHIP. The Ministry of Health and Long-Term Care pays for a wide range of services, however, it does not pay for services that are not medically necessary, such as elective surgery.
Most of Ontario health benefits are covered across Canada. When travelling to other provinces or territories, you may be required to bill the Ontario Ministry of Health and Long-Term Care directly for hospital and physician services. In Quebec, you may have to pay for physician services and then submit your receipt to your local ministry office for payment.
For more information on OHIP and coverage, please refer to:
The Ministry of Health and Long-Term Care (MOHLTC) website.
Call the Ministry’s ServiceOntario, INFOline at 1-800-664-8988
(Toll-free in Ontario only)
Hours of Operation: 8:30 a.m. - 5 p.m.
Third Party Coverage/Programs
The Ontario Association of Optometrists (OAO) promotes the importance of regular comprehensive eye examinations. In 2004, the Ontario Ministry of Health and Long-Term Care removed OHIP coverage for regular eye examinations for adult patients between the ages of 20 to 64. Only adult patients with certain medical conditions continue to be covered for annual eye examinations under the Schedule of Benefits for Optometry Services.
If your eye examination is not covered by OHIP, we recommend that you check your current health insurance company’s benefit plan (i.e., Manulife, Sun Life, Green Shield of Canada, Great West Life) for vision coverage. Many employers have extended health-care benefits for employees including vision health coverage. OAO encourages you to contact your insurance carrier for further information so that you are aware of your coverage when booking your appointment with a Doctor of Optometry.
Doctors of Optometry can choose to either bill a third party or a patient for the fee. If a patient pays for an insured service, the third party will reimburse either all or part of the fee.
In addition, the following links provide detailed information and eligibility criteria on third party programs under the Provincial and Federal government:
Please ensure that you provide your Doctor of Optometry with your coverage information when booking an appointment.