OHIP (Ontario Health Insurance Plan) is the provincial health care plan funded by the Government of Ontario which covers many health expenses including eye exams. OHIP eye exam coverage is not universal, nor is it particularly straightforward. This article will be your guide to OHIP eye exam coverage.

Who Should Know About OHIP Eye Exam Coverage?

If you are studying to enter the eye care field, as either an Optometrist, an Optician, an assistant, or a receptionist, you are sure to work with OHIP in one way or another. You might need to; verify a patient’s eligibility to use the services, submit a claim for payment, enter data into your patient-management-system, and answer common questions from patients or potential clients. So, it pays to know how OHIP eye exam coverage works.

Services Available through OHIP Eye Exam Coverage

In general, OHIP covers three main services, including major eye exam, minor eye exam, and visual field assessment for individuals who meet the eligibility criteria. Also, the Ontario Ministry of Health and Long-term Care defines the scope of each of these services, let’s take a look;

Major Eye Exam

Also referred to as Routine or Periodic Oculo-Visual Assessment, or Comprehensive Eye Exam. A major eye exam is a complete examination of the health of the eye and its structure, plus refraction.

Minor Eye Exam

Also known as Oculo-Visual Minor Assessment, or Partial Eye Exam. A minor assessment could be any eye problem such as eye infections, allergic eye reactions, eye injuries, etc.

Visual Field (VF) Assessment

Automated Visual Field assessment is done using an instrument called a perimeter, and it maps out the extent of a person’s field of view. An OHIP-covered VF assessment is usually done when the optometrist finds suspicious or alarming signs during a major assessment.

Eligibility Criteria

What Will You Need?

Anybody seeking an OHIP covered eye exam must provide a valid Ontario health card at the time of the exam.

For whom does OHIP cover eye exams?

Children – 0 to 19 Years Old

Children aged 19 and under are eligible for;

  • A comprehensive eye exam once every 12 consecutive months (once per year).

  • Any required minor assessments throughout the year.

Note: A prescription check is only covered once per year during the comprehensive eye exam.

Seniors – 65 Years and Over

Seniors 65 years old and over are eligible for;

  • A comprehensive eye exam once every 12 consecutive months (once per year).

  • Any required minor assessments throughout the year.

Note: A prescription check is only covered once per year during the comprehensive eye exam.

Adults- 20 to 64 Years Old

Adults between the ages of 20 to 64 do not have OHIP eye exam coverage unless;

  • They have been referred to the optometrist by a primary healthcare professional (i.e. physician, or a registered nurse). The referring doctor must complete a Request For Major Eye Examination form and the patient must take this form to the optometrist,

Note: In this case, the person is eligible for one major assessment and one minor assessment related to the initial chief complaint per year for 5 years.

  • They receive financial aid from ODSP (Ontario Disability Support Program) or OW (Ontario Works),

Note: Individuals receiving ODSP or OW benefits are eligible for OHIP covered eye exam once every 24 consecutive months (once every 2 years).

  • They have been diagnosed with one of the 10 conditions listed below;
  1. Diabetes Mellitus (Type 1 & 2)
  2. Glaucoma
  3. Cataract
  4. Retinal Disease
  5. Amblyopia
  1. Visual Field Defects
  2. Corneal Disease
  3. Strabismus
  4. Recurrent Uveitis
  5. Optic Pathway Disease

Note: In this case, the person is eligible for 1 major eye exam once every 12 consecutive months, plus necessary minor exams (follow-ups).

Optometry Fee Schedule

The Ontario Ministry of Health and Long-term care has defined a fee schedule for OHIP eye exam services. The fee schedule is a guide for eye care professionals that outlines the amount payable to the optometrist for OHIP-covered eye exams. It also assigns a unique code to each service and eligibility criteria.

Fee Code Service Age Group(s)
V402   Minor Assessment 19 & under, and 65 & over
V404   Major Assessment 19 & under
V406   Major Assessment 65 & over
V408   Minor Assessment 20-64 (conditional upon V409)
V409   Major assessment 20-64 (Conditional)
V410 VF Assessment   Conditional upon V404, V406 & V409
V450   Major assessment 20-64 Receiving ODSP Benefits
V451 Major assessment 20-64 Receiving OW Benefits

Common Questions about OHIP that We Have Heard from Clients


Sometimes, when you ask patients for their health card they wonder why you need it, or what you are going to use it for. There are a few reasons you can tell your patient to educate & reassure them.

Eligibility: The main purpose of the health card is to determine whether a person is eligible for coverage under OHIP or not. When a patient’s eligibility is verified with the Ministry of Health and Long-term Care, OHIP will pay the expenses.

Payment: Once an eligible patient received treatment, the optometrist submits a claim for the eye exam to the Ministry. This way, the patient doesn’t have to pay out of pocket, and the optometrist gets reimbursed for the service he/she provided.

Identification: You should ask for a patient’s health card regardless of his/her eligibility, and coverage status. Since every individual has a unique health number, this is an alternative way to identify patients in your database. It also helps to avoid confusion when you have two people with the exact same name. (Believe me, it happens!) Plus, the health number is the perfect reference for communications -regarding the medical needs of a certain individual- between healthcare providers. So, make sure you ask for it when patients come to your office for eye care services.


If you hear this from a person between 20-64 years old, it means he/she hasn’t been to the eye doctor in a looooooooong time! First, encourage them to get their eyes checked, then explain to them that the eye exam used to be covered under OHIP for all age groups back in the early 2000s. However, this has changed in November 2004. Since then, only children, seniors, and adults with specific conditions are covered by OHIP.

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