 Is my Eye Exam Covered By OHIP?
This page excerpted from the Ontario Ministry of Health pamphlet
You may have heard that Ontario physicians are currently working under a 2.9% clawback, which they forced the government to reduce from 10% after a doctor's strike. Optometrists have 11% of their OHIP billings withheld, and have laboured under this system for the last three years.
What is covered by OHIP?
OHIP pays for your eye exam ONLY once every 2 years if you are 19-65, but still covers it yearly if you are younger than 18 or older than 66. (OHIP does not cover your eye exam if it is combined with a third party request.)
OHIP also pays for eye exams done for:
- devices provided by a Ministry of Health program, such as the Assistive Devices Program for low-vision patients.
- people identified by a Ministry of Health screening program to be in need of further eye testing.
- the paperwork involved in Northern Ontario travel grants.
- information provided to other health professionals about the health of your eyes.
What isn't covered by OHIP
If someone other than you or a health professional requires you to have an eye exam or needs information about your vision, it is a third-party service. In most cases it is not covered by OHIP.Your regular eye exam is covered by OHIP unless it is combined with a third party request. In that case it is not covered. Examples of third party services are those for:
- employers
- pilot's driver's marine or other licence applications
- insurance purposes, including motor vehhicle accident claims
- legal proceedings, including business or oter contracts
- educational institutions
- daycare and camps
- disability benefits
These third party services include eye exams and related paper work.
Other services not covered by OHIP
Employer eye exams for safety glasses. Your employer may want you to have an eye exam for safety glasses or need information about the exam. These services are not covered by OHIP.
Contact lens services. Following initial assessment most services related to contact lenses are not insured by OHIP. Ask your Optometrist for details.
If my eye exam isn't covered by OHIP, who pays?
You are responsible for payment of services not covered by OHIP.In some cases a third party may repay you or pay for the services directly. Your Optometrist can tell you what services are are not paid by OHIP and what fees will be charged. This is not extra-billing. Third party services are not covered at all by OHIP. Please talk to your Optometrist when you phone for an appointment.
How can I get more information?
Call the Ministry of Health's Infoline: 1-800-268-1154 or TDD?TTY" 1-800-387-5559
|
