OHIP vision care

OHIP covers the cost of one major eye exam (for vision and general eye health) every 12 months, plus any minor assessments you need, but only if you are:

• 19 years and younger
• 65 years and older

If you are 20 to 64 years old, and you have a specific medical condition affecting your eyes that requires regular monitoring, OHIP will cover a major eye exam for you once every 12 months and any follow-up appointments related to the condition.

Covered conditions are:

• diabetes mellitus
• glaucoma
• cataract
• retinal disease
• amblyopia
• visual field defects
• corneal disease
• strabismus
• recurrent uveitis
• optic pathway disease

OHIP may also cover a major eye exam if it has been requested for a specific reason by your doctor (they will need to give you a referral form).

You may be eligible for additional eye care if you are on the Ontario Disability Support Program (ODSP) or Ontario Works.

OHIP does not cover:

• eyeglasses
• contact lenses
• laser eye surgery

Latest important changes in OHIP vision care

People aged 65 and older will be covered for one eye exam every 18 months, instead of one a year, unless they have a condition affecting their eyes such as macular degeneration, glaucoma or diabetes.

Under the agreement, seniors will no longer be able to receive unlimited minor follow-up assessments after an annual eye exam. Instead, they would be able to get two of those assessments every 18 months, or 12 months for seniors with certain medical conditions affecting their eyes.

Adults between age 20 and 64 with lazy eye will no longer be covered for eye exams. People in that age range with strabismus — who are currently covered for eye exams — will now only be able to receive them through OHIP if the condition has a sudden onset.

People with cataracts are currently covered for eye exams, they will only be covered if they have “clinically significant decreased vision that impacts their daily life” or if a surgery referral is made.

People with retinal disease, corneal disease and optic pathway disease will only be covered if their cases are active, as opposed to being insured for an eye exam at any time.

Currently, any OHIP patient is covered for a visual field assessment, but going forward only people with certain conditions such as retinal disease, glaucoma, active optic pathway disease, and acquired cranial nerve palsy causing strabismus will be covered for them.

For patients with diabetes, a documented history of the disease is currently required in order for the patient to receive an OHIP-insured eye exam, but as of Sept. 1 optometrists can make a clinical assessment themselves.

Right now, people with inflammation (known as uveitis) can receive an insured eye exam if they have the condition on a recurring basis, whether the eye is inflamed or not at the moment. Starting Sept. 1, uveitis no longer has to be a recurring condition for the patient to qualify, but people will only be covered with current inflammation.

Ontario Blue Cross Vision Care Insurance to help offset expenses OHIP doesn’t cover

Vision issues can affect your quality of life. Proper vision is important for everyone, and problems with your vision can have significant social and financial effects. Most eye care problems are preventable with proper care. This is why vision care coverage is so essential.

Ontario Blue Cross vision care benefit helps cover the cost of eye examinations and eyeglasses or contact lenses that are not covered by the OHIP. Without vision care benefits, you are responsible for paying these costs, and with Canadians living longer and the population getting older, it’s becoming increasingly important to have extra health insurance to stay healthy.

Whether you’re self-employed, retired, don’t have group insurance or need additional coverage, Ontario Blue Cross flexible health insurance plans offer a variety of affordable options to eliminate expensive and unforeseen health costs.

Sources:

https://www.ontario.ca/page/what-ohip-covers#section-6

https://www.health.gov.on.ca/en/public/publications/ohip/docs/eyecare_fs_en.pdf