Advisory: Potential changes to eye exam coverage under the Ontario Health Insurance Plan (OHIP) effective September 2021

News Release

Advisory: Potential changes to eye exam coverage under the Ontario Health Insurance Plan (OHIP) effective September 2021
The Ontario Association of Optometrists has indicated their intention to withdraw from the Ontario Health Insurance Plan (OHIP) effective September 1, 2021.
This will affect individuals who have been eligible to receive eye exams under OHIP until this date.
Those affected should be aware that these services cannot, by Ontario law, be charged to private health insurance.

Who is affected?
This will affect patients aged 19 and under, and 65 and over who have been eligible under OHIP for the coverage of one major eye exam every 12 months, plus any minor assessments.
This will also affect those of any age with certain medical conditions including glaucoma and retinal disease who receive eye exams covered under OHIP.

Why can these services not be charged to private insurance?
Ontario regulation prohibits optometrists from billing direct to patient, or to workplace health insurance, or to individual private insurance for any services provided to those eligible under OHIP.
In other words, optometrists may decline eye examinations to OHIP-eligible patients.
Residents of Ontario between the ages of 20 to 64 may continue to receive eye examinations under the terms of their workplace health insurance, or individual private insurance plan.

Additional information
The Canadian Life and Health Insurance Association is continuing to monitor this situation. We will advise of any updates as we become aware of them.
If you have additional questions, you can find the contact information for your insurer on your contract or at www.olhi.ca/for-insurers/member-list/.
Information about OHIP can be found on the Government of Ontario’s website at https://www.ontario.ca/page/what-ohip-covers.