Eye exam insurance coverage in Canada

First published on March 19, 2011

I’d previously mentioned that by relying completely on online contact lens and glasses retailers or even opticians, you miss out on potentially useful eye health exams. I recently decided to visit an optometrist for the first time since elementary school and found out first-hand about the decent insurance coverage that is potentially available for an eye exam.

A routine eye exam for people between the ages of 19 and 64 is usually not covered by MSP. However, in my case, the optometrist discovered a potential area of concern that warrants further investigation. For that reason, a portion of the initial routine exam fit the description of “medical necessity” and thus 37% of the exam fee was covered by MSP — even though I went in for the exam without any specific eye problems or concerns. This is listed on the bill as “MSP Major Eye Exam Coverage”. The remaining amount is 80% covered by my company’s Pacific Blue Cross benefits plan, and I was even able to submit the insurance claim online and potentially without having to mail in the receipt. In the end, my fee for the “Comprehensive Ocular Exam” will be $15.

I had a good experience at the BC-based optometrist group Pacific eyeDoctors. In addition to being able to spot specific eye problems, an eye exam can also identify health problems such as diabetes and complications from high blood pressure. The doctor explained the reasoning for each of the tests that were run and walked me through her assessment of the images they took of my eyes. She also answered my general questions about ambient lighting when working on a computer (you want a bit of lighting coming mostly from over your shoulder), and about suitable contact lenses for my usage. I was given a quote for some contact lens packages that compare well to online deals, but I was not pressured to make a purchase (and I have not done so… yet).


One Response to “Eye exam insurance coverage in Canada”

  1. freshgreen says:

    hope ur ok PK! no eye exams since elementary???? why???

    i have always learned a lot in the office and with the contact lenses fitter…it’s useful to have consultations cuz these are our eyes rite?

    xoxooxo ur big day is almost here….excited for u n mel :)

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