Contact lenses, laser eye surgery, or prescription eye glasses — those out-of-pocket expenses may make you think twice about visiting an optometrist for an eye check-up.
That’s why health insurance helps with vision care expenses for you and your family.
Having an eye exam helps prevent eye diseases and treats disorders. Watch this video by the Canadian Association of Optometrists for great information on when you should have an eye exam.
Many general health conditions are first detected through an eye exam — and many serious eye conditions don’t have obvious symptoms. From infancy to grade school, throughout your working life and into retirement, eye exams not only ensure the quality of your vision and your eye health, but the quality of your life.
Depending on where you live, eye exams might be covered by your provincial healthcare plan. In Ontario, eye exams are covered by OHIP for people under the age of 20 and over the age of 65, as well as for many with low incomes. Everyone else must pay for exams out of pocket or submit a claim to their health insurance plan to help cover the cost.
Most health insurance plans fund up to $80 for an exam every two years, making it easy to keep on a schedule for regular eye check-ups.
If a problem is detected at your eye exam, your optometrist may recommend glasses or contact lenses. You may opt to have laser surgery for long-term correction. Here’s what is covered:
- Glasses and Lenses
Under most health insurance plans, funds are available for glasses or lenses (including tinting) every 24 consecutive months. Eligibility for vision benefits is always based on the date of the last paid vision care claim. Some insurance companies allow a two-week grace period, but check with your insurer to know when exactly you are eligible.
- Contact Lenses
These are covered, provided they are for prescription use only. Even though you will likely purchase contacts more often than glasses, they are still subject to your maximum allowable amount. Lens solution, cases, and other accessories are not eligible for reimbursement.
- Laser Surgery
Most plans will reimburse an amount equal to your regular vision care coverage maximum (and no more). While the procedure can be expensive, many clinics offer payment plans. Plus, you will save on the cost of glasses or contact lenses over the longer term. Your health insurance plan may also cover costs for prescription eye drops and other medications.
In store, your eye doctor may be able to direct bill your insurance company for services. If you have paid for them directly – buying glasses or contact lenses online for example– you must pay for your glasses in full to be eligible for reimbursement.
To reimburse you, your insurance provider will require an original receipt that states the following:strong>
- The patient’s name
- The date of eye exam or service, or date of purchase
- The contact information of the optometrist or vision care center
- A list of services or items purchased
- The total cost (if glasses or contacts, the date paid in full)
You will need to send this receipt, along with a signed original medical claim form, if you are submitting it by regular mail. If you opt to submit your claim online, retain your receipt in case your file gets audited.
Your vision is priceless. Routine eye exams by an optometrist not only ensure good vision and eye health, but peace of mind. Talk to SBIS today about the health insurance you need. We’re here to help.