The Ontario Association of Optometrists is planning to withdraw from Ontario’s Health Insurance Plan (OHIP) on September 1, 2021.

Currently, OHIP pays for one annual routine eye exam for Ontarians ages 19 and younger and 65 and over.

This could mean some Ontarians can’t get a routine eye exam

After the withdrawal from OHIP:

• Optometrists may refuse to provide routine eye exams to people ages 19 and under, and 65 and over.
• By law, optometrists can’t charge patients in these age groups directly for eye exams. In other words, patients cannot pay directly for the service.
• Under the same law, insurers cannot cover the costs of their routine eye exam, either. This includes workplace plans and private insurance plans.

What does this mean for your plan members?

If your plan covers plan members or dependents ages 19 years old and younger, or 65 and over:

• You and Sun Life can’t cover the cost through your Extended Health Care benefit plan or Health Spending Account, if applicable.
• They may not have access to eye exams at all, as patients cannot pay out of pocket.

We’ll continue to repay eligible claims for eye exams for Ontarians ages 20 to 64, inclusive, as usual.

We’re continuing to monitor this

We’re continuing to monitor the situation through the Canadian Life and Health Insurance Association (CLHIA). We’ll advise you of any changes.

Questions? We’re here to help.

If you have fewer than 50 employees, please contact the Client Relations Representative Team at 1-866-606-8936.

If you have more than 50 employees, please contact your Sun Life Group Benefits representative.