What Is ODSP
Today, we are going to learn about ODSP vision care benefits. So far in our series of provincial vision care benefits, we have covered OHIP. Let’s see how the ODSP vision care benefits are going to unfold! ODSP or the Ontario Disability Support Program is a provincial social assistance service provided by the Ministry of Children, Community and Social Services (MCSS). ODSP provides assistance with essential life and medical expenses for individuals with a physical or mental disability, who are not able to work due to the complications caused by their disability. It also covers the individual’s family members, like their spouse, and dependant children under 18.
Frequency of ODSP Vision Care Benefits
ODSP recipients are eligible to receive vision care benefits as long as the frequency criteria are met. Frequency criteria are slightly different for adults and kids.
Adults and their spouses are eligible for;
- A routine eye exam once every 24 months (2 years)
- Prescription eyeglasses once every 3 years
- Repairs or replacements as necessary
Dependent kids under 18 are eligible for;
- Prescription eyeglasses whenever there is a change in prescription
- Repairs or replacements as necessary
If you are wondering about kids’ eye exam, read this post to learn more.
What Vision Care Benefits ODSP Offers
ODSP offers a number of vision care benefits to its recipients, including;
- Full coverage for Routine Eye Exam
- Partial coverage for Prescription Eyeglasses for Adults & Kids
Below, I’m going to explain the process for each service briefly.
Routine Eye Exam
The cost for a routine eye exam will be fully covered by OHIP. However, to use this benefit the recipient has to provide his/her health-card, Statement of Assistance, or other forms of ID to the optometrist. Using any fo these, the optometrist can determine whether the recipient is eligible for a routine eye exam and if eligible claim the expense so the patient doesn’t have to pay out of pocket.
Prescription Eyeglasses
ODSP covers costs associated with prescription eyeglasses up to a maximum, once every three years. After an eye exam, an eye care provider can inform the patient whether an upgrade is necessary. The optometrist or the optician does that by considering both the up-to-date prescription and the patient’s current glasses (if any available). Patients have the option to purchase prescription eyeglasses from a different provider. Nonetheless, before purchasing eyeglasses there are a couple of things the patient and the provider should do. First, discuss the available options, coverage amount referring to the MCSS Vision Care Fee Schedule, and inform the patient of any out-of-pocket expense. Then, make sure the patient obtains an Authorization/Invoice for Vision Care Form, before proceeding with the order. To obtain this form the patient can take the prescription to their local ODSP office in person. Alternatively, the eye care provider can fax it in, given that they have the contact information for the patient’s caseworker.
Summary
ODSP is a provincial social assistance program for people with disabilities. Vision care benefits are one of the many services provided by ODSP. Patients receiving ODSP are eligible to receive vision care services as long as the frequency criteria are met. MCSS has a fee schedule available for service providers, which sets out the maximum amount payable to the provider. If the cost for prescription eyeglasses is more than what’s covered by MCSS, the patient has to pay the difference out of pocket. So it is important that a clear discussion with the patient is done during the consultation and recorded for both the provider and the patient’s reference.