OHIP coverage

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PLEASE NOTE:  As of September 1, 2023, OHIP has changed their policies and coverage.

 

Although changes in OHIP coverage have occurred, the standard of care provided by Dr. Lee and Specs on Bloor have not changed.  Dr. Lee continues to believe in the annual eye exam as the most effective tool in prevention of ocular eye conditions and disease.

Even though OHIP may not cover it, annual eye exams can still be paid out of pocket or through personal or work insurance coverage.

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New OHIP coverage summary:

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For patients aged 65 and over: 

OHIP continues to cover the cost of one major eye exam (for vision and general eye health) every 12 months, but only if you have been diagnosed with certain eligible medical conditions such as macular degeneration and glaucoma.

 

**For patients aged 65 and over and have not been diagnosed with an eligible medical condition,

OHIP covers one eye exam every 18 months.

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For patients aged 19 and under:

OHIP continues to cover one eye exam every 12 months.

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However, certain sight threatening conditions that require regular monitoring are eligible for coverage between the ages of 20 to 64 years old.  Patients must be assessed by the doctor before this can be determined. Please bring any supporting documentation or medication if possible.  Please note that certain eye conditions that were previously covered under OHIP such as amblyopia and strabismus are not longer considered an eligible medical condition.

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Partial exams:

Previously, partial exams for certain age groups were covered at an unlimited basis.

With the new changes, only TWO partial visits are permitted to be covered under OHIP.

If the usage of the two partial visits cannot be confirmed, payment will be required and if OHIP coverage can be verified, the fee can be refunded.

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A valid ohip card must be brought to every visit.

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For more information, please visit www.OHIPupdates.ca