Changes to OHIP coverage for eye care services

Effective November 1, 2004

Routine eye exams, provided by either an optometrist or physician, for patients aged 20 to 64 are no longer covered by OHIP. These individuals will now pay for this service or have the cost of exams covered by private insurance.

Eye Care Services Covered by OHIP

  • Changes will not affect seniors or those under age 20. People 65 and older and under 20 will continue to have OHIP coverage for a routine eye exam once every 12 months.
  • Changes will not affect ophthalmology services for patients of any age with medical conditions or diseases affecting the eyes.
  • All persons receiving assistance under the Ontario Disability Support Program, Ontario Works or the Family Benefits Program will continue to receive coverage for routine eye exams 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 exam once every 12 months. Prior to November 1, 2004, eye exams 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 exam:
    • 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 exam. They should discuss this with their primary healthcare provider.