Optometric services

Covered services

You may benefit from certain optometric services covered by the public plan if you have a valid Health Insurance Card.

Services covered for any insured persons

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.

Examples of sudden eye problem

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

You have to pay for certain additional non-covered services:

• Referral to another optometrist or ophtalmologist practising at the same location
• Treatments and care (extracting a foreign body or prescribing a medication, for example)
• Supplementary tests to establish a diagnosis, such as photographing the ocular fundus

Covered services depending on your situation

You may benefit from optometric services free of charge if you have a valid Health Insurance Card and in any of the following situations:

• You are under age 18
• You are age 65 and older
• 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 (the mention ​“YES” must appear under ​“Message” in the Eye Examinations section of your claim slip)
• You are age 60 to 64, have been a recipient of the Allowance (Guaranteed Income Supplement through your spouse) for at least the past 12 consecutive months and have a valid claim slip (carnet de réclamation), where the mention ​“YES” must appear under ​“Message” in the Eye Examinations section of your claim slip

List of covered services

The following services are offered free of charge upon presentation of your Health Insurance Card and a valid claim slip (carnet de réclamation) if you have one:

• Administration of eye drops during a covered service
• 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 when required for employment purposes and required by a Québec law (bus, heavy vehicle, commercial or emergency vehicle)
• Examination under cycloplegia, which includes the use of a medication that temporarily paralyzes the muscles of the eye to measure and analyze refraction
• Prescription of exercises to improve vision
• Referrals to another health professional following an examination: ophthalmologists, physicians, specialized nurse practitioners
• Writing of optometric reports specific to a covered service and intended for other health professionals (physicians, dentists, optometrists, pharmacists, specialized nurse practitioners)
• Writing and handing over of prescriptions for eyeglasses or contact lenses (corneal lenses) following an examination
• Reimbursement of eyeglasses or contact lenses for children under age 18

Conditions for certain examinations

Depending on your situation and the type of examination required, certain conditions must be met for the examination to be covered at no cost.

Complete examinations and evaluation of colour vision

• Under age 18: 1 examination per calendar year (January 1 to December 31)
• Age 65 and over: 1 examination per calendar year
• Age 18 to 64, recipients of a financial assistance program with claim slip (carnet de réclamation) for at least the past 12 consecutive months: 1 examination every two calendar years
• Age 60 to 64, recipients of the Allowance (Guaranteed Income Supplement through your spouse) for at least the past 12 consecutive months and have a valid claim slip (carnet de réclamation): 1 examination every two calendar years

Orthoptic examinations: Diagnoses of strabismus and other evaluations

Age 16 and under: 1 examination per calendar year (January 1 to December 31)

Examinations with dilation of the inner eye and retina

You must be in one of the following situations:

• Under age 18
• Age 65 and over
• Age 18 to 64 with a valid claim slip (carnet de réclamation) for at least 12 consecutive months

You must also have received one of the following diagnoses:

• Diabetes treated with a medication
• Myopia of 5 diopters or more

Non-covered services

You have to pay optometric services that are not covered by the public plan.

Examples of non-covered services

• Purchase and replacement of eyeglasses or contact lenses except for persons who are eligible for the financial assistance program See Better to Succeed
• Fitting of eyeglasses or contact lenses
• Corrective laser surgery or other eye surgery aimed at doing away with eyeglasses or contact lenses unless the following 2 conditions are met:
  • Documented failure regarding the wearing of eyeglasses or contact lenses
  • Anisometropia of more than 5 diopters or astigmatism of more than 3 diopters
• Examinations to obtain a driver’s licence (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 unless the form is included in an examination required for employment purposes and required by a Québec law
• Optical coherence tomographies
• Treatments necessary following an eye emergency