OHIP eligibility and eye exam coverage in Ontario

Official sources

OHIP coverage rules are set by the Ontario Ministry of Health. The most current details are published here:

• Ontario: OHIP coverage for eye care services: https://www.ontario.ca/page/what-ohip-covers#section-6

Who is typically covered for routine eye exams

In Ontario, OHIP coverage often depends on age and medical eligibility. Confirm your situation using the official Ontario page linked above.

• Children and teens: under 20
• Seniors: 65+
• Adults 20 to 64: routine eye exams are generally not covered unless you meet medical eligibility

Medical eligibility for adults aged 20 to 64

Adults aged 20 to 64 with certain medical conditions may be eligible for an OHIP-insured eye examination on a defined schedule.

The Ontario listing has historically included conditions such as:

• diabetes mellitus
• glaucoma requiring or having had treatment with medication, laser (excluding prophylactic laser peripheral iridotomy), or surgery
• cataracts / posterior capsular opacification with a visual acuity of 20/40 or worse in the best corrected eye, or when a surgery referral is made
• retinal disease that is acute, or is chronically progressive
• corneal disease that is acute, or is chronically progressive
• active uveitis that is acute or chronic during episodes of active inflammation
• optic pathway disease that is acute, or is chronically progressive
• acquired cranial nerve palsy resulting in strabismus during the acute phase or until the condition resolves or stabilizes
• ocular drug toxicity screening for patients taking hydroxychloroquine, chloroquine, ethambutol or tamoxifen

Please confirm current eligibility on the Ontario page linked above.

What OHIP covers vs what it does not

OHIP typically covers the core insured eye exam for eligible patients.

Advanced imaging beyond OHIP is part of our standard of care because it improves patient care and clinical outcomes. These services are not covered by OHIP and involve additional fees.

Fees and recommended testing

Recommended testing is based on clinical judgment and the information needed to provide appropriate care. Applicable fees are explained upfront.

Some services are not covered by OHIP and may be eligible for reimbursement through third-party insurance, depending on the plan. Coverage varies by insurer and policy.

If you have questions about eligibility or coverage, please contact our office before booking.