Questions about coverage?
Our office works with many different organizations to find the best coverage for your eye exam and glasses. We can direct bill ODSP, WSIB or OW so a portion or even all of your visit will be covered.
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Contact us if you have any questions about your coverage!
OHIP
The Ontario Health Insurance Plan covers the cost of a major eye exam once every 12 months, plus any minor assessments you need for patients 19 years and younger or 65 years and older.
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If you are 20-64 years old, your visit may be covered if you have a specific medical condition affecting your eyes that requires regular monitoring. In this case, OHIP will cover a major eye exam once every 12 months and any minor assessments needed. Covered conditions include but are not limited to: diabetes mellitus (if you are taking medication for it), glaucoma, cataract, retinal disease.
There is no coverage under OHIP for glasses or contact lenses.
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Although, many third party insurance companies may cover a portion of your eye exam or glasses/contact lenses.
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We highly recommend that patients check their insurance coverage before their appointment.
Note that it is up to the examining doctor to diagnose your disorder and under certain circumstances, proof of medication or a letter from your physician may be required to obtain OHIP coverage for your examination.
ODSP
The Ontario Disability Support Plan covers the cost of a major eye exam once every 2 years for you and your family if coverage under OHIP is not available.
All first time patients eligible for ODSP coverage are subject to a $30 charge for baseline fundus (retinal) photography. This charge is not covered.
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Please bring your Member ID on a ODSP statement and the name of your caseworker to your visit.
Assistance with the cost of prescription eyeglasses is provided once every 3 years, or under extenuating circumstances like a significant prescription change or broken frames.
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Please note, ODSP will not fully cover glasses, patients are expected to cover the rest of their glasses after ODSP coverage.
If you do not have your Member ID and caseworker name, we cannot bill your visit or glasses to ODSP and you will be expected to cover your visit or pay for your glasses upfront.
WSIB
The Workplace Safety and Insurance Board may cover some or all of your major eye exam along with some or all of your minor or follow up assessments.
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All first time patients eligible for WSIB coverage are subject to a $30 charge for baseline fundus (retinal) photography. This charge is not covered.
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Please bring your claim ID with you.
Assistance with the cost of prescription eyeglasses is a possibility depending on what WSIB will cover.
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Please note, in times where WSIB will not fully cover for the patient's glasses or visit, the patient is expected to cover the rest.
If you do not have your claim ID, we cannot bill your visit or glasses to WSIB and you will be expected to cover your visit or pay for your glasses upfront.
OTHER COVERAGE
Our office also works with Ontario Works (OW), as well as Health Claims for Auto Insurance (HCAI).
If you have any other questions about your coverage, feel free to give our office a call and our admin desk would be more than happy to help!