In Canada , the provinces control healthcare and determine what services are medically necessary. Provincial health care insurance, e.g. OHIP in Ontario and the REGIE in Quebec, will only pay for services they deem to be medically necessary.
Eye examinations for a regular check-up for patients 19-64 years of age are NOT covered unless you have a cataract, glaucoma, diabetic retinopathy, macular degeneration, strabismus, amblyopia or an emergency.
Before OHIP or the REGIE decides to cover the cost of any new medicine or treatment, it is often years after it has been approved by Health Canada and the evidence is strong enough that the outcomes warrant the cost.
Many new treatments for glaucoma, cataracts and macular degeneration are available but not covered. Some are covered by your extra health insurance, e.g. GMSIP or Manulife, but if they consider it experimental they may not cover it.
Examples of Non-Insured Treatments
Optic nerve scans for glaucoma, laser measurements for cataract surgery, multifocal implants for cataract surgery, blue-blocker implants for cataract patients with macular degeneration, intravitreal injections of new agents for macular degeneration and some visudyne treatments are just a few examples of NON-INSURED new treatments available at The Ottawa Hospital but paid for by the patient directly.
Discuss your options with your specialist about what is best for your particular case. Patients enrolled in a research study might not have to pay for experimental treatments.
- In Ontario, newer soft, foldable implants are covered but the REGIE in Quebec only covers the older, rigid implants. The Ottawa Hospital charges $200 for the foldable implant if you are not covered.
- Cosmetic and esthetic surgeries are NOT covered unless they are pre-cleared by OHIP.
- Refractive surgery to eliminate glasses such as excimer laser PRK, LASEK, LASIK and clear lens surgery are NOT covered by OHIP or the REGIE except under exceptional circumstances post-surgery like a corneal transplant.
Some physicians are opted into the Quebec plan but others are not. Sometimes a sub specialist form or referral is required to have it covered. Often you are directly responsible for the costs.
An anesthesiologist is part of the team and attends most operations. Their cost may not be covered by your insurance if your surgery is not covered or they are opted out of the REGIE. Similarly, you may be responsible for your pre-assessment exam before surgery if you are undergoing non-insured surgery. Ask the pre-assessment staff if you are covered.