Answer a few quick questions. This is a guide only — we'll always confirm your coverage at your visit.
Since September 2023, only progressive eye diseases qualify — stable conditions are no longer OHIP-insured. What counts?
OHIP requires documentation of the condition to bill your exam medically.
OHIP covers one routine exam per period — if your last one was inside it, your next covered exam isn't due yet.
As of September 2023, only progressive eye diseases and conditions are covered through OHIP. Stable eye conditions are no longer covered.
Progressive means the condition is actively changing and needs ongoing monitoring — for example diabetes with eye involvement, glaucoma, or macular degeneration. OHIP also expects proof of the condition, such as medication records, test results, or a referral from your doctor.
Not sure where you fit? Bring whatever documentation you have and we'll check it with you before anything is billed.
OHIP covers medically necessary eye care. Imaging, treatments and testing for forms sit outside that — but private insurance usually helps.
If you fall into one of these groups, your routine eye exam is covered.
These aren't OHIP-insured — but most private plans cover them, and we bill directly.
Even when OHIP covers your exam, any scans you choose to add are billed separately. The good news: your $90 exam fee doesn't apply, so you only pay for the imaging. See exam & scan pricing →
Between OHIP and your private insurance, most patients pay far less than they expect — here's how it's handled.
Bring your health card. If your exam is OHIP-insured, we bill OHIP directly and the $90 exam fee doesn't apply to you.
For anything OHIP doesn't cover — scans, treatments, glasses — we can direct-bill most private insurers, so you're not paying up front and waiting for reimbursement.
Whatever's left after OHIP and your insurance. We'll give you an estimate up front, but many insurers only confirm what they'll pay once the claim has actually been submitted — so the final figure is settled after your visit.
Insurance predeterminations are estimates and may not always be accurate. We'll tell you your estimated out-of-pocket cost right away, but the final amount is determined by the insurance company after the exam is completed and the claim is processed.
It's best to call your insurer beforehand so you know exactly what's covered and for how much.
If you're 65 or older, OHIP covers one routine eye exam every 18 months, so you don't pay our $90 exam fee. If you have diabetes, glaucoma or another progressive eye condition, that becomes every 12 months. Either way, any imaging scans you choose to add are billed separately — private insurance often covers them.
It does. Diabetes makes your eye exam OHIP-insured every 12 months at any age, not just under 20 or over 65 — and if you're a senior, it moves you from the 18-month interval to 12 months. Diabetic eye changes often appear before you notice any symptoms, which is why regular exams matter — and why we frequently recommend a macula OCT scan alongside them.
As of September 2023, only progressive eye diseases and conditions are covered through OHIP — stable eye conditions are no longer covered. Progressive means the condition is actively changing and needs monitoring, such as diabetes with eye involvement, glaucoma, or macular degeneration. A condition that is stable and unchanging generally no longer qualifies. OHIP also expects documentation — medication records, test results or a referral from your doctor. If you're unsure which category you fall into, bring what you have and we'll check it with you.
OHIP insures the exam itself, not advanced imaging. Optomap and OCT scans are considered enhanced diagnostics, so they're paid privately. Almost all private insurance plans do cover them, and we can bill your insurer directly.
Your routine exam is $90. Most workplace and private insurance plans cover it in full or in part, and we can direct-bill them. Any imaging you add is priced separately — see our exam pricing page for the full breakdown.
No. You can book directly with us for any of our services, including dry eye treatment and application testing.
Your health card, your insurance details, your current glasses or contact lenses, and a list of any medications you take. If you're here for application or form testing, bring the form your service gave you.
Call us with your health card handy and we'll confirm your coverage in a minute — before you book anything.
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