Insurance and OHIP coverage

Adults - 20 to 64 years are not covered by OHIP and will have to pay for their eye examination. Most insurance companies and University/College health insurance will provide coverage for eye examinations as well as for glasses and/or contact lenses. Please call your insurance provider and find out what type of coverage you have prior to your eye examination. Patients can also elect to pay and submit the forms and receipt to their insurance company themselves.

At North York Eye Clinic, we can direct bill for the cost of your eye exam, eyeglasses and contact lenses on your behalf directly to the insurance company. The patient would be responsible for paying any difference/balance remaining. 

Adults - 20 to 64 years of age with certain ocular/ medical conditions such as:  

* Glaucoma requiring or having had treatment with medication, laser (excluding prophylactic laser peripheral iridotomy), or surgery; 

* Cataracts / posterior capsular opacification with a visual acuity of 20/40 or worse in the best corrected eye, or when a surgery referral is made;

* Retinal disease that is acute, or is chronically progressive; * Corneal disease that is acute, or is chronically progressive; 

* Uveitis that is acute or chronic during episodes of active inflammation; 

* Optic pathway disease that is acute, or is chronically progressive; 

* Acquired cranial nerve palsy resulting in strabismus during the acute phase or until the condition resolves or stabilizes; 

* Ocular drug toxicity screening for patients taking hydroxychloroquine, chloroquine, ethambutol or tamoxifen;

* Diabetes mellitus.

Adult patients with the medical conditions above  will be OHIP covered for a full eye exam every year with their OHIP card.   Partial eye examinations at the office are limited to a maximum of two services per 12-month period per patient following the full oculo-visual assessment. Any services beyond this limit are uninsured. 

Diabetic and glaucoma patients must bring their medications or a pharmacy print out list of their medications with them to their eye exam or they will be charged and will have to pay. Diabetic patients can also choose to have their family physician fax over a referral letter to the office. The office fax number is: 647-352-5559.