OHIP Guidelines

A few years ago, you may remember the petitions that were circulating throughout Ontario, inquiring to the provincial government to raise the amount of money that optometrist were being paid for their eye examination services for those 19 and younger, 65 and older, or with a diagnosed medical condition who are covered through OHIP. After many deliberations and conversations between the optometrists of Ontario and the provincial government, they came to a mutual agreement that prioritizes both care for patients and reimbursement for optometrists. As per this change, beginning September 1st, 2023, there were some alterations made to OHIP coverage.

Children 19 and younger will remain unaffected by OHIP changes as it is increasingly important to monitor their vision regularly during their growing years. Newly, the coverage for those 65 and older has had some changes, now either covering patients every 12 months or 18 months dependent upon the health of the eye. Patients 65+ with a diagnosed, serious, sight-threatening ocular or medical condition will continue to be monitored annually. Patients 65+ with no serious, sight-threatening conditions, and stable eyes aside from prescription changes, will be monitored every 18 months. It is also important to know that patients 65+ are covered for 2 partial eye examinations in between their major eye examinations if there have been any sudden changes in their ocular health. In addition, coverage for those between the ages of 20-64 who were seen through their OHIP card may no longer be covered. Many of the ocular/medical conditions that were covered are no longer covered if the condition is stable. Diabetic patients will remain to be covered annually through OHIP.

The guidelines outlined by OHIP for coverage are very extensive and specific. If you are unsure of your coverage, please feel free to kindly call our office at 613-549-2020 and we can have our optometrist review your file and determine your eligibility. We appreciate your patience as we navigate through these changes with you.