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Coverage for Routine Eye Care Services
Under age 20 or 65 years and older: covered for a routine eye examination once every 12 months plus any follow-up assessments that may be required.
Ages 20-64: You may be covered for certain conditions (see below) or by another government program (i.e. ODSP, Ontario Works). All others must pay out of pocket or use private insurance.
Referrals to Ophthalmology: If you are referred to an ophthalmologist for a medically necessary condition, the referral and services are usually covered for patients of all ages for medical conditions or diseases affecting the eyes.
Those with specific medical conditions: Patients (all ages) with specified medical conditions affecting the eye (diabetes and specific diseases) can receive an insured regular eye examination once every 12 months.
Medically necessary conditions: Patients (all ages) with the following conditions receive an OHIP insured eye examination:
- diabetes mellitus
- retinal disease
- visual field defects
- corneal disease
- recurrent uveitis
- optic pathway disease
Persons aged 20 to 64 who have certain medical conditions not listed above may also be covered for regular eye examinations under specific circumstances if their primary health care provider (family doctor) provides a requisition form.
Eye Care Services Not Covered
Routine eye examinations for patients aged 20 to 64 are not covered by OHIP. Patients must pay out-of-pocket or (when available) bill to their private insurance plan(s).
Persons receiving assistance through the Ontario Disability Support Program, Ontario Works, or the Family Benefits Program may be eligible for coverage for routine eye examinations once every two years. Call Client Services at Ministry of Community and Social Services (MCSS) at 1 888 789-4199 (toll free) or 416 325-5666 (Toronto) or 1 800 387-5559 (TTY) for further information.
Frequently Asked Questions
Are insured persons between 20 and 64 exempt from paying for eye examinations if they have certain specific medical conditions?
Patients aged 20 to 64 years who have any of the following medical conditions can go to their optometrist or physician and receive an OHIP insured eye examination once every 12 months : diabetes mellitus, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent uveitis or optic pathway disease.
Do persons aged 20 to 64 with other medical conditions that may affect their eyes need to get a physician referral in order to see their optometrist now?
Insured persons aged 20 to 64 who have conditions not listed above may also be covered by OHIP for a regular eye examination.
They should discuss this with their primary health care provider (e.g. family doctor or nurse practitioner). If their primary care provider determines they have a medical condition that requires regular monitoring, a requisition will be provided where appropriate for an OHIP covered eye examination. A requisition is valid for up to five years.
I am 52 and have diabetes. How often will OHIP pay for me to see my eye care physician or optometrist?
OHIP pays for you to have one regular eye examination every 12 months. OHIP also covers any related follow-up assessments you require before you have your next major eye examination.
How much will routine optometry eye examinations cost for people who are not covered by OHIP? Will the cost be regulated?
The optometrist determines patient fees. The ministry does not regulate these fees.
If you have any questions regarding eye care services coverage please contact: Ministry of Health and Long-Term Care at 613 536-3103 (collect calls are accepted) or toll-free at 1 888 662-6613.