Optometric services

Who is eligible?

You may benefit from optometric services free of charge if you are insured by the Québec Health Insurance Plan and in any of the following situations:

• You are under the age of 18 or age 65 or over
• You are age 18 to 64 and have been a recipient of a financial assistance program with claim slip (carnet de réclamation) for at least the past 12 consecutive months
• You are age 60 to 64, have been receiving a spouse’s allowance under the Old Age Security Act for at least the past 12 consecutive months (without this allowance, you would be eligible for financial assistance program with claim slip (carnet de réclamation) benefits) and hold a valid claim slip (carnet de réclamation)
• You have a visual impairment (additional condition: you must register with a recognized facility specialized in visual aids)

Services covered for eligible persons

The following services are covered only for eligible persons. Certain restrictions apply. To obtain these services, you have to present your valid Health Insurance Card. Recipients of financial assistance program with claim slip (carnet de réclamation) and persons age 60 to 64 must also present their valid claim slip (carnet de réclamation).

• Examinations to detect vision disorders, monitor their evolution and assess eye health
• Examinations specific to a particular condition, such as strabismus or aniseikonia (the image seen by one eye differs from that seen by the other)
• Eye examinations to obtain a driver’s licence (bus, taxi, commercial or emergency vehicle)
• Cycloplegic examinations, which entail the use of eye drops to temporarily paralyze the focusing eye muscles in order to measure and analyze refraction
• Prescription of exercises to improve vision
• Writing of a report at the request of another health professional, for instance, an ophthalmologist
• Writing and handing over of prescriptions for eyeglasses or contact lenses (corneal lenses) following an examination
• Reimbursement following the purchase of eyeglasses or contact lenses for children under 18

Restrictions concerning examinations

Complete examinations and evaluation of colour vision

• Under age 18: 1 examination per year
• Age 65 or over: 1 examination per year
• Recipients of financial assistance program with claim slip (carnet de réclamation) age 18 to 64: 1 examination every 2 years

Orthoptic examinations: Diagnoses of strabismus, among other conditions

Covered only for children age 16 or under

Examinations with dilation of the inner eye and retina

Covered for persons being treated for diabetes and those with myopia of 5 diopters or more

Services covered for all

Emergency examinations performed by optometrists are covered for all insured persons experiencing a sudden eye problem. All you need to do is present your valid Health Insurance Card. Here are some examples:

• Conjunctivitis
• Inflammation of the eyelid
• Foreign body of the surface of the eye

On the other hand, you have to pay for certain additional non-covered services:

• Treatments (extracting a foreign body or prescribing a medication, for example)
• Supplemental tests to establish a diagnosis such as photographing the ocular fundus

Services not covered

You have to pay for certain optometric services. Here are some examples:

• Purchase and replacement of eyeglasses or contact lenses, except for under 18s
• Fitting of eyeglasses or contact lenses
• Corrective laser surgery or other eye surgery aimed at doing away with eyeglasses or contact lenses
  Exception
  The surgery is covered if the following 2 conditions are met:
  • Documented failure regarding the wearing of corrective eyeglasses or corneal lenses
  • Anisometropia of more than 5 diopters or astigmatism of more than 3 diopters
• Examinations to obtain a driver’s licence for a passenger vehicle or motorcycle
• Photos of the retina or Optomap
• Writing of reports of an eye examination required by educational institutions, employers, insurers, summer camps, associations or organizations
• Optical coherence tomographies
• Treatments necessary following an eye emergency