There are changes to OHIP coverage

As of September 1st, 2023, OHIP has changed the criteria for OHIP coverage for some individuals.

See below for the main changes most notably the list of eligible medical conditions that are covered by OHIP and terms of coverage for full examinations and follow up examinations.

Read the detailed press release of the changes from the Ontario government here.

Eligible medical conditions

The list of eligible medical conditions that are covered by OHIP has been updated to include the following:

• Glaucoma (requiring or having had treatment)

• Severe cataracts (requiring referral for surgery)

• Retinal disease that is acute or chronically progressive

• Corneal disease that is acute or chronically progressive

• Uveitis that is acute or during periods of active inflammation

• Optic pathway disease that is acute

• Acquired cranial nerve palsy resulting in strabismus during the acute phase

• Ocular drug toxicity screening for patients taking Plaquenil or Tamoxifen

• Diabetes Mellitus

If you are 65 years and older

Individuals who do not have an eligible medical condition are covered by OHIP for a full comprehensive eye examination every 18 months. Additionally they are allowed two (2) follow up visits every 18 months

If you have an eligible medical condition, you are covered by OHIP for a full comprehensive eye examination every 12 months. Additionally, they are allowed two (2) follow up visits every 12 months.

If you are between ages 20-64

Individuals are eligible for an OHIP covered eye exam only if they have one of the conditions from the updated eligible medical conditions list. Additionally, they are allowed two (2) follow up visits every 12 months.

Requisition for a major eye exam forms from a physician or nurse practitioner are no longer covered by OHIP unless they have one of the eligible medical conditions.