New Changes to Optical Coverage in Ontario

By April 6, 2023 No Comments

Press Release – April 6, 2023

On Tuesday March 21, 2023, members of the Ontario Association of Optometrists ratified a new four-year funding agreement with the Government of Ontario; they had been without an agreement since September 1, 2021. The crux of the issue was that Optometrists had been subsidizing these $80 exam visits as the government was only reimbursing $44. OHIP covers one Optometrist visit per year for children under 19 and adults over age 65. In an effort to demand changes to reimbursement levels, Ontario Optometrists withdrew from OHIP as of Sept 1, 2021, and began a job action that lasted until November 21, 2021.

During the job action, eye exams for children under age 19 and adults aged 65 and older were not eligible to be paid under benefit contracts as Optometrists are a ‘designated profession’ identified under the Medical Care Act and cannot provide a service to someone covered by OHIP for cash payment or bill directly to a private payor. As a result, your employees may have had to pay for these service out-of-pocket.

Effective April 1, 2023, payments to optometrists increased for some OHIP covered optometry services.

The agreement also increases access to care for people with chronic diseases such as glaucoma and ocular complications due to diabetes. Those aged 65 or older who are diagnosed with an eligible medical condition requiring ongoing monitoring will continue to receive an OHIP-insured annual eye exam as well as two follow-up minor assessments. In addition, covered individuals aged 65 and older will continue to receive preventative eye care through an OHIP-insured eye exam every 18 months, as well as two additional follow-up minor assessments.

There are no changes to the coverage for children.

Click here to review of all the changes that took effect April 1, 2023.