Navigating the world of healthcare services can sometimes feel like a maze, but when it comes to eye health, it’s essential to know what services are covered and how they benefit you and your family.
The Ontario Health Insurance Plan (OHIP) covers essential eye exams for children, seniors, and those with certain medical conditions. Let’s take a closer look at what OHIP covers in terms of eye exams and why regular eye check-ups are crucial for everyone, from the youngest child to the wisest grandparent.
What Does OHIP Cover?
OHIP provides coverage for a variety of healthcare services, including some aspects of vision care. The kind of coverage you can expect depends on your age and any health issues. If you’re not sure how it affects you, why not check out your coverage? You might be in for a pleasant surprise!
Children & Youth Coverage
Children under 19 should get an eye exam every 12 months, which is exactly what OHIP covers!
This coverage includes 1 major eye exam each year that assesses both vision and general eye health. In addition to the major exam, OHIP also covers minor appointments throughout the year. These minor appointments can address specific concerns or conditions uncovered during the main exam, such as providing guidance and treatment options for nearsightedness or other common eye issues.
Regular eye exams are crucial in ensuring the healthy development of a child’s vision, detecting any potential problems early, and providing timely interventions to maintain optimal eye health.
Senior Coverage
If you’re over 65 and have an eye condition such as macular degeneration, glaucoma, or diabetes, you’re eligible to receive 1 comprehensive eye exam every 12 months. This plan also includes 2 minor follow-up assessments to monitor and manage your eye health.
On the other hand, if you’re over 65 and don’t have an eligible medical condition, OHIP will still cover 1 major eye exam every 18 months. This coverage also provides the same 2 minor follow-up assessments, so you can receive adequate eye care even without a specific medical condition.
Adults with Eligible Medical Conditions
OHIP has got your back (and your eyes) if you’re between 20–64 with certain medical conditions. Eligible conditions include:
- Diabetes
- Glaucoma
- Vision-impacting cataracts (yes, this can include surgery!)
- Retinal disease
- Corneal disease
- Optic pathway disease
- Acute or chronic uveitis
- Strabismus from acquired cranial nerve palsy
- Ocular drug toxicity screening for meds like hydroxychloroquine, chloroquine, ethambutol, or tamoxifen
Remember, coverage can vary based on how severe your condition is, so chat with your optometrist or family doctor. If you’re eligible, you get 1 major eye exam every 12 months and 2 extra follow-up visits.
Who Can Get OHIP Coverage?
To get your OHIP health card, you need to meet a few requirements.
The basics for OHIP are:
- Being in Ontario for at least 153 days within any 12 months
- Staying in Ontario for at least 153 out of the first 183 days after you move here
- Having your primary place of residence be in Ontario
Plus, you need to meet at least one of these additional requirements. Most of the time, you’re probably good to go, but it’s always worth double-checking. You could be:
- A Canadian citizen
- An Indigenous person registered under the federal Indian Act
- A permanent resident
- Applying for permanent residency
- On a valid work permit and working full-time for at least 6 months
- A refugee or other protected person
- Holding a Temporary Resident Permit
- A clergy member ministering for at least 6 months
So, make sure to check these off, and you’ll be on your way to getting your OHIP card!
Why Do I Need an Eye Exam?
Our eyes deal with a lot of daily strain. We work with them, we play with them, so we need to take good care of them! One of the best ways to keep our peepers in top shape is through regular eye exams. These check-ups can detect early signs of issues like glaucoma or macular degeneration before they can sneak up on us. The sooner a problem is spotted, the better the chances of beating it!
Plus, eye exams help us see clearly! Our vision changes over time, and you might not even notice until you start squinting at street signs. For kids, clear vision is key to learning and growing. It’s hard to ace school if you can’t see the board!
We recommend different eye exam schedules based on age. Here’s a handy guide for the whole family:
- 6–9 months: Babies should have their first eye exam.
- 2–5 years: Kids should have at least 1 more eye exam before starting school.
- 6–19 years: An annual check-up.
- 20–64 years: At least 1 exam every 2 years.
- 65+: An annual exam.
Remember, this is just a general guide. We might suggest more frequent visits if you have ongoing vision issues. So look after those eyes—they’re worth it!
Book Your Eye Exam
Take a moment to check your OHIP coverage. If you’re covered, why not take advantage of it? Of course, OHIP isn’t the only option. Some people may need supplemental coverage, but ensuring your eyes are well taken care of is worth it to see all the beautiful sights with your family.
Our friendly team at Queensway Optometric Centre is passionate about sight at all ages and can work with you to help your family get the care you deserve. Keep the future bright and book your eye exam today!
