OHIP Coverage
From September 1, 2023, the Ontario Ministry of Health (MOH) will implement updates to OHIP coverage for eye exams. These changes are designed to prioritize the provision of publicly funded care for individuals at risk of or currently living with specific eye conditions, aiming to prevent vision loss. Below you can see a summary of OHIP changes:
For Children Aged 0-19 Years
There have been no modifications to the existing coverage policy.
OHIP will maintain its coverage for patients in this age group, offering one comprehensive eye examination every 12 months. Additionally, OHIP will continue covering "partial" visits related to specific issues, such as red eye, or any follow-up appointments recommended by a doctor.
For Adults Aged 20-64 Years
OHIP does not cover patients within this age group unless the patient has one or more of the following potentially sight-threatening conditions, which are eligible for one comprehensive eye examination every 12 months under OHIP.
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Diabetes (confirmed cases only)
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Glaucoma (confirmed cases only)
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Retinal Disease
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Corneal Disease
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Optic Nerve Disease
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Cataracts (only if visual acuity is worse than 20/40 or surgery is needed)
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Uveitis
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Sudden-onset Strabismus (like those related to a tumor or nerve palsy)
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Certain medication usage: Chloroquine, Hydroxychloroquine, Ethambutol, Tamoxifen
Starting from September 1, 2023, OHIP coverage for patients with Amblyopia or longstanding Strabismus will cease. However, OHIP will provide coverage for up to two "partial" visits related to the diagnosed eye condition. OHIP would not cover additional visits or partial visits unrelated to the specific eye condition.
Seniors (65+ years)
OHIP Coverage
To qualify for one comprehensive eye examination every 12 months under OHIP, seniors aged 65 and above need to have at least one of the following potentially sight-threatening conditions:
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Diabetes (confirmed)
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Glaucoma (confirmed)
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Retinal Disease
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Corneal Disease
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Optic Nerve Disease
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Cataracts (only if visual acuity is worse than 20/40 or surgery is needed)
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Uveitis
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Sudden-onset Strabismus (like those related to a tumor or nerve palsy)
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Certain medication usage: Chloroquine, Hydroxychloroquine, Ethambutol, Tamoxifen
If a senior patient doesn't have one of these specified conditions, the frequency of coverage changes from every 12 months to every 18 months. However, we strongly advise seniors to maintain an annual comprehensive eye examination to proactively identify and address potential eye diseases. The fee for an eye exam is $156 which we can charge to private insurance plans if you have one. Alternatively, patients can choose to wait until 18 months to access an OHIP-insured exam.
In addition, OHIP allows for up to two 'partial' exams to be covered between each comprehensive exam for all seniors aged 65 and over.
maintain Your Eye Health with Regular Checkups
Dr. Wendy Ng, leading optometrist at Chic Eyes, highly recommends all patients, regardless of age or OHIP eligibility, to have an annual eye examination. Detecting eye diseases early is crucial for preserving vision and ensuring well-being. If you have any questions about these changes or wish to book an appointment, please feel free to reach out to us at (289) 467-6000.
We look forward to seeing you soon!