A Closer Look at Canada’s Vision Benefits

Wellbeing should be a crucial part of social services. As seen in former New Zealand PM Jacinda Ardern’s movement to increase the wellbeing budget in the country, these services can cover a variety of important fields—including health and vision health. Canada offers similar programs, with a universal healthcare system funded by taxes.

But if you’re a Canadian who feels that you aren’t making the most of your vision benefits, you’re not alone. Over 38% of Canadian adults are overdue for an eye exam, with cost cited as one of the main reasons for delay. Additionally, those who can avail of coverage for eye care don’t plan to use their vision benefits before they expire.

According to data from Benefits and Pensions Monitor, one of the main reasons Canadians don’t take advantage of vision benefits is that they don’t know what exactly they cover. So, if you have these benefits, why not take the time to learn more about them? Here’s a quick and easy overview of what they cover to get you started.

Eye exams

Many eye care professionals will tell you that regularly getting your eyes examined is the single most important thing you can do to care for your vision. That’s because many blindness-causing conditions, like glaucoma, don’t exhibit any symptoms. A comprehensive eye exam—not just the basic vision test that gets you a glasses prescription—is the only thing that can detect these issues so you can get them treated as soon as possible. Vision benefits cover routine eye exams, with “routine” typically meaning every two years.

The amount of coverage you can avail of for an eye exam fee depends on the type of plan you have. The most basic ones, for example, typically cover $50, while more premium ones cover up to $100. Without insurance, this fee can reach up to $160. If you’re currently employed, check your benefits package to see what tier insurance plan you fall under.

Your dependents can also get eye exams depending on their age and where you all live. For Albertans aged under 18 or over 65, for example, yearly assessments come free of charge under AHCIP. Ontario, however, recently changed its OHIP limits for seniors, who can now only get a free exam every 18 months.

Prescription eyewear

Eyesight can negatively impact your quality of life. Blurred eyesight caused by short- or farsightedness, for example, can limit your ability to read, write, work, and even drive. This makes eye exams important for both diagnosing vision conditions and getting new or updated prescriptions for the necessary eyewear. As such, the vision benefits offered by many providers go beyond exams and cover not just eyeglass purchases, but also those made for contact lenses and even prescription sunglasses.

As with eye exams, you can generally avail of this coverage every two years, with the amount reimbursed also depending on your tier. Basic plans cover a minimum of $100, while premium ones can go as high as $300. Without insurance, you may end up paying more than $500 for prescription glasses and sunglasses, as well as up to $800 for contact lenses, depending on the type.

What this means is that, even with a basic plan, you get the freedom to choose where you get your eyewear. You don’t necessarily have to buy whatever’s the cheapest option, especially if they don’t suit you. Even Ray-Ban provides eligible invoices for reimbursement when you buy its eyeglasses. After choosing from even popular frames like the Clubmaster and Wayfarer Ease Optics, all you need to do is contact customer service, get your invoice, and submit it to your insurance provider. That makes this vision benefit particularly crucial, as it accounts for the fact that even prescription eyewear should be purchased according to user preferences.

Corrective procedures

These may be the first things that come to mind when you think of what vision benefits cover, as procedures like surgery are the last resort when eye conditions progress to the point where they can’t be corrected with eyewear. Insurance also comes in handy in these cases, as procedures like cataract surgery can be expensive. When offered by for-profit vision centres, they become even more inaccessible to those who cannot afford them. As such, vision benefits often cover a number of corrective procedures.

However, this coverage usually applies to those under high insurance tiers and can be reimbursed up to $500 for a procedure. Many provincial plans also only cover treatments meant to correct specific conditions, such as those for glaucoma, cataracts, and macular degeneration. That means they don’t reimburse the money spent on other common surgeries, including LASIK and photorefractive keratectomy or PRK, which are designed to correct refractive errors like short-sightedness, far-sightedness, and astigmatism.

Should you get private vision insurance?

Though the benefits included in healthcare insurance plans are already quite comprehensive, you may want to consider getting stand-alone vision insurance from a private provider depending on your needs. For example, you can get a family plan that allows you to buy corrective eyewear more frequently than every two years. That can be especially helpful if you have kids—who are likely to change prescriptions or break their corrective aids more often. If your current benefits don’t cover LASIK, it’s also worth considering looking at private vision insurance plans that do cover it, especially if you wish to undergo the procedure down the line.

Can you opt out of vision benefits?

If you prefer to pay for the above procedures and aids out-of-pocket or avail of them outside your provider’s current network, you can also consider opting out of your vision benefits. Those on a student plan can also opt out if they’re currently enrolled as a dependent in one of their parent’s plans.

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