The following persons are entitled to the covered services without having to pay:
- persons under the age of 18
- persons age 65 and over
- persons age 18 to 64 who have been recipients of last-resort financial assistance for at least the past 12 consecutive months
- persons age 60 to 64 who have been receiving a spouse's allowance under the Old Age Security Act for at least 12 consecutive months and who, without this allowance, would be entitled to last-resort financial assistance benefits
- visually impaired persons
In the event of a sudden eye problem such as conjunctivitis or inflammation of the eyelid, or where there is a foreign body on the surface of the eye, persons eligible for the Health Insurance Plan are covered only for an emergency examination, performed by an optometrist, in order to establish the diagnosis.
These services are mainly:
- examinations of the oculo-visual system, which makes it possible to detect vision disorders, monitor their evolution and assess eye health
- examinations specific to a particular condition, such as strabismus or aniseikonia (a condition in which the image seen by one eye differs from that seen by the other)
- evaluation of colour vision, visual field, eye motility and light adaptation
- prescription of eyeglasses or contact lenses following an examination, prescription of exercises to improve vision, or referral to another health professional such as an ophthalmologist
Persons under the age of 18 and those age 65 and over are entitled to only one insured complete eye examination and only one insured colour vision test per calendar year.
Recipients of last-resort financial assistance are entitled to the same services once every 2 calendar years.
Orthoptic examinations, which allow for the diagnosis of strabismus, among other conditions, are covered only for children 16 years of age or under.
Examination, with dilation, of the inner eye and the retina is covered only for:
- persons treated for diabetes
- persons with myopia of 5 diopters or more
The Société de l'assurance automobile du Québec charges for the eye examinations required to obtain a driver’s licence (commercial or emergency vehicle, bus and taxi). The Régie pays these costs for covered persons.
Procedure to follow
To receive free of charge the insured services provided by an optometrist, just present your valid Health Insurance Card. If you are a recipient of last-resort financial assistance, you must also present your valid claim slip (carnet de réclamation).
Visually impaired persons must register with an accredited rehabilitation centre.
Services not covered
The optometric services not specified in the Regulation respecting the application of the Health Insurance Act must be paid by the insured person. For example:
- the purchase, fitting, and replacement of eyeglasses or contact lenses
- eye examinations required by educational institutions, employers, insurers, summer camps, associations or organizations
- eye examinations to obtain a licence to drive a passenger vehicle or motorcycle