While the withdrawal of provincially-insured eye services by Ontario optometrists is unlikely to have a direct impact on benefits plans, it could cause a “trickle-down effect,” according to Kim Siddall, vice-president of enterprise consulting for the west at People Corporation.
“Given that under Ontario law, insurers can’t cover the cost of the eye exams which were covered by the Ontario Health Insurance Plan prior to Sept. 1, there won’t be an impact to extended health or health-care spending account programs or the eye exam benefit under a plan sponsor’s vision care benefit.”
Optometrists withdrew these services Sept. 1, following a breakdown in talks with the provincial government over the reimbursement of costs. The province said about 2.9 million Ontario residents received provincially insured optometry services in the 2019/20 fiscal year.
However, the job action will effectively prevent access to eye exams for people aged 19 and under, 65 and older and those with specific health conditions, all of whom are currently covered under OHIP and therefore not eligible for private coverage. “This could cause a trickle-down effect in missed opportunities for early detection of eye disease, depending on how long these Ontarians are unable to access routine services,” says Siddall.
Dr. Sheldon Salaba, head of the Ontario Association of Optometrists, said his group’s members are currently paying for around 45 per cent of those services. He said there will be a delay in service for people covered by OHIP until talks resume.
The province has offered to pay optometrists $39 million to retroactively account for increased costs of services. It has also offered to increase reimbursement by 8.48 per cent. Salaba said optometrists want an increase of 70 per cent to close the gap.
When the OAO first announced its intention to withdrawal from OHIP in early August, the Canadian Life and Health Insurance Association said in a statement that these services, under Ontario law, can’t be charged to private health insurance plans.
“Ontario regulation prohibits optometrists from billing direct to patient or to workplace health insurance or to individual private insurance for any services provided to those eligible under OHIP.
In other words, optometrists may decline eye examinations to OHIP-eligible patients.”