When will OHIP pay for my eye exam?
OHIP covers one comprehensive eye exam per year until the day you turn 20. Those 65 years and older are covered annually when they have a diagnosis of progressive eye disease, and every 18 months when they don’t. Follow-up appointments many also be covered for these age groups.
OHIP will also cover an annual examination for those between age 20 and 64 when certain progressive sight-threatening eye diseases are diagnosed. These include clinically-significant cataract, glaucoma, retinal disease, keratitis, uveitis, and optic pathway disease. You are also covered by OHIP for annual exams if you have diabetes. Individuals who carry these diagnoses may also be eligible for up to two follow-up examinations, as necessary, and as long as they are related to the initial condition. For example, you might be seen twice a year to assess your diabetic eye disease, and those appointments are covered. If, however, you develop an eye infection within the year, that appointment would not be covered because it is dealing with a new unrelated issue.
OHIP does not cover the cost of appointments related to therapies, such as contact lens assessments, low vision training, or vision therapy. In addition, second opinions and third party requests (ie. Ministry of Transportation) are not covered for any age group.
