OHIP – Frequently Asked Questions
When are eye exams covered by OHIP?
Comprehensive eye exams are COVERED by OHIP for children (up to 19 years of age) and seniors (65 and older) once every 12 months. Additional partial exams during the year are also OHIP insured for children and seniors (refraction is only covered once every 12 months).
When can an adult patient (age 20-64) have their eye exam paid for by OHIP?
Adult eye exams will be paid by OHIP if you have one of the following 10 medical conditions: diabetes, glaucoma, cataract, retinal disease, amblyopia, visual field defects, visually significant corneal disease, strabismus, recurrent uveitis and optic pathway disease.
Do patients (20-64) with one of the above 10 medical conditions need a physician referral to see an optometrist?
No. However, if you do not have one of the 10 conditions and your family doctor or nurse practitioner determines you require an OHIP insured eye exam for medical reasons, they will give you a “Request for Major Eye Exam Form” (MEE form).
Are patients (20-64) on diet control for diabetes covered by OHIP for an eye exam?
Yes. Any diagnosis of diabetes is OHIP insured for a full eye exam every 12 months, whether controlled by diet or medication. If required, OHIP also covers minor follow-up care for those with diabetes before their next major eye exam.
If a patient (20-64) goes to an optometrist with a possible infection or foreign body in the eye, will OHIP pay for the exam?
No. The exam will not be covered for a simple red eye unless there is visually significant keratitis (corneal inflammation). The exam would only be covered by OHIP if requested by a family doctor or a nurse practitioner, providing the patient with an MEE form.
If a patient (20-64) has cataract surgery, are post-surgical exams covered by OHIP?
Yes. The patient will be covered for one post-op exam and refraction. Any future exams will not be OHIP insured unless the patient qualifies for coverage with an MEE form or has one of the 10 medical conditions listed above.
Are patients (20-64) with a prosthetic (artificial) eye covered by OHIP?
Yes, they are allowed one full eye exam every 12 months.
Please click here to visit OHIP’s website for more information.