Our team at Ham’s Superior Vision Centre understands that figuring out what the Ontario Health Insurance Plan (OHIP) covers for your eye care can feel like a puzzle. You want to keep your vision sharp and your eyes healthy, so it helps to understand what to expect.
OHIP coverage for eye exams depends on your age and whether you have certain medical conditions that affect your eyes. Some have full eye exam coverage, while others only have coverage under specific circumstances. And knowing these details helps you plan for your family’s vision care.
OHIP Eye Exam Coverage for Kids and Teens
OHIP provides coverage for eye care to support healthy vision during critical developmental years for anyone aged 19 and younger. This coverage makes it easier to keep up with your child’s changing vision needs as they grow. Coverage includes:
- A full eye exam once every 12 months
- All minor assessments as needed
OHIP Rules for Adults Aged 20–64
Adults aged 20–64 don’t have eye exam coverage in all instances. But if you have a specific medical condition that affects your eye health, you should qualify for 1 major exam every year and up to 2 additional follow-up assessments. This coverage helps you manage conditions that could impact your sight.
Medical Conditions that Qualify for Coverage
Some of the conditions that qualify you for this additional coverage include:
- Diabetes
- Glaucoma
- Visually significant cataracts
- Progressing or Active Retinal disease
- Progressing or Active Corneal disease
- Active Uveitis
- Optic nerve disease
- Optic pathway disease
- Cranial nerve palsies (you are currently missing this too)
- Use of medications such as hydroxychloroquine, chloroquine, ethambutol, or tamoxifen that require ocular drug toxicity monitoring
Vision Care and OHIP for Seniors
Once you turn 65, OHIP provides some coverage for eye exams. Even if you don’t have one of the above eligible medical conditions, you should qualify for 1 major exam every 18 months with 2 additional follow-up assessments.
Exams for Specific Eye Conditions
If you have an eligible eye condition, such as macular degeneration, glaucoma, or diabetes, OHIP covers a major eye exam once every 12 months because more frequent check-ups help manage these conditions effectively.
What OHIP Usually Does Not Cover
While OHIP helps with medically necessary services, there are some vision-related costs it doesn’t typically pay for. It’s helpful to know what to plan for so you can budget accordingly for your eye care needs.
Common Exclusions
- Routine eye exams for adults aged 20 to 64 without an eligible medical condition
- Eyeglasses and contact lenses
- Innovative diagnostic tests, such as retinal imaging or OCT scans, which can give a more detailed view of your eye health
- Appointments just for getting contact lenses fitted
While OHIP may cover eye emergencies when they are assessed by a family doctor, urgent care clinic, or hospital emergency department, emergency visits are not always insured when provided by an optometrist.
Why Regular Eye Exams Matter for Everyone
Even if OHIP does not cover your routine exam, it is still a key part of your overall health care. Visiting your eye doctor does more than just check your vision; it provides a look into your overall health.
A Window to Your Overall Health
Your eyes can show early signs of other health conditions, not just eye diseases. A comprehensive exam can help spot issues before you notice other symptoms, which makes a big difference in managing your health.
For example, the small blood vessels in your retina can show signs of high blood pressure or diabetes, sometimes before you are diagnosed. An eye doctor can also spot early indicators of other issues, giving you a chance to address them with your family physician. This window into your health makes your eye exam a valuable part of your proactive health routine.
Book Your Next Eye Exam with Us
Your vision deserves great care, and regular exams make all the difference. With locations on Oliver Road and in Centennial Square Plaza, Ham’s Superior Vision Centre makes it easy for you and your family to access quality eye care close to home. Reach out today to book your next eye exam.
