How vision insurance works in Ontario
Most working-age adults in Ontario (20-64) are not covered by OHIP for routine eye exams. If you have vision coverage, it almost certainly comes through your employer benefits plan — and that plan is what determines what you pay out of pocket.
The problem is that every plan is different. Two patients with Sun Life can have completely different coverage. So when patients ask “do you take my insurance?” the answer is almost always yes — but “what does my plan cover?” depends on your specific employer.
Here is how vision plans generally work and what to expect.
What your plan typically covers
Most employer vision plans in Ontario include some combination of:
Eye exam allowance
- Covers one eye exam every 12 or 24 months (varies by plan)
- Some plans pay the full exam fee, others cover a set dollar amount
- Coverage for additional imaging (retinal photos, OCT) varies — some plans include it, others do not
Glasses allowance
- A dollar amount for frames and lenses, typically every 12 or 24 months
- Allowances range from $150 to $500+ depending on the employer plan
- Usually applies to a complete pair (frame + lenses together)
- If the total exceeds your allowance, you pay the difference
Contact lens allowance
- A separate dollar amount for contact lenses
- Some plans let you claim both glasses and contacts in the same period; others make you choose one or the other
- The allowance covers the lenses themselves — fitting fees may or may not be covered separately
Health spending account (HSA)
- Some employers provide an HSA — a flexible pool of dollars you can apply to any eligible health expense, including vision
- HSA funds can cover the gap between your plan allowance and the actual cost
- If you have an HSA, bring those details too
What we cannot tell you
We can look into your coverage before your appointment if you share your plan details. But there are limits to what we can confirm in advance:
- Your insurer determines final coverage, not us — we submit the claim, they adjudicate it
- Plan details change — your employer may update benefits at renewal without notifying you
- Frequency limits are specific — “every 24 months” might mean calendar years, or it might mean 24 months from your last claim date
This is not us being evasive. Insurance systems genuinely vary, and we would rather be honest about what we can and cannot confirm than promise something your plan does not cover.
What we can do
- Direct-bill your plan so you pay only your portion at the time of service
- Check your coverage at the appointment in real time for most plans
- Provide a detailed receipt if your plan requires you to submit claims yourself
- Help you time your visit around your benefits cycle if that matters to you
Plans we direct-bill
We direct-bill over 30 insurance providers. The most common plans our patients use include:
- Sun Life Financial
- Manulife Financial
- Canada Life
- Green Shield
- Desjardins Insurance
- Medavie Blue Cross
- RBC Insurance
- Equitable Life of Canada
- TELUS AdjudiCare
For the complete list, see all insurance plans we direct-bill.
If your plan is not set up for direct billing, we provide a detailed receipt you can submit to your insurer for reimbursement.
What to do before your appointment
- Find your insurance card — or take a screenshot of your member ID, group number, and plan details
- Share your details in advance if you can — email or call us and our team will look into your coverage before you arrive
- Check your benefit year — if your benefits reset on a specific date, you may want to time your visit accordingly
- Ask your employer about your HSA — if you have one, it can cover costs beyond your vision allowance
If you do not have insurance
A comprehensive adult eye exam at Spadina Optometry costs $198. Children and seniors pay a supplemental fee on top of OHIP coverage. All fees are explained upfront — there are no surprise charges.
For full pricing, see fees and pricing.
Related pages
Not sure what your plan covers?
Share your insurance details before your visit and our team will look into what is covered. Or bring your card and we will check at the appointment.
Prefer to talk first? Call or text us at 416-703-2797.
Last reviewed: April 13, 2026