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Children’s Eye Exams in Alberta: What’s Covered?

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smiling child with glasses next to her mother with glasses
When you look at children, it’s easy to remark how often they seem like the picture of health. They adapt to changes in their health quickly, but that adaptive resilience can be an issue as well. Children can mentally adapt to changes in their vision, so they might not even know when there’s a problem, even while the problem gets worse. That’s why waiting for symptoms to arise exposes growing children to unnecessary risk. A children’s eye exam is the best way to catch and address eye issues early.
School-aged children from ages 6-19 need annual eye exams. Infants should have at least one eye exam between 6 and 9 months old and toddlers should have one between 2 and 5 years old
That added expense can be an issue since vision care usually falls under private health care benefits in Canada. If you are living in Alberta, there is still some coverage for children’s eye exams to make sure your child is getting the eye care they need.

Why Get Your Child’s Eyes Checked

Some of the statistics on vision care for children are alarming. A randomly selected 1000 person sample from across Canada in 2018 revealed recent trends in children’s eye care.
This study found that 1 in 2 Canadians under 18 years of age are diagnosed with an eye disease, and nearly 1 in 6 of those are diagnosed with conditions that can’t be fixed by corrective lenses. Less than 6 in 10 adults took their children for an exam, screening, or diagnostic test in the prior year. 22% say they don’t have their children’s vision checked at all. 
child getting an eye exam from an optometrist

Insurance Coverage for Children in Alberta

Typically adults are on their own from ages 19 to 65 when it comes to eye exams, and in Canada, many turn to their private healthcare benefits for fees coverage. Others have to pay out of pocket.
But in Alberta, there’s some full and partial coverage for vision care included in the Alberta Health Care Insurance Plan (AHIP), commonly known as Alberta Health. Alberta Health allows you to get up to three different eye care visits covered for your child per year:

  • 1 routine eye exam
  • 1 partial exam
  • 1 diagnostic visit or procedure

For Albertans under 18, the types of visits covered include up to one routine eye exam, one partial exam, and one diagnostic procedure. A routine eye exam will cover multiple vision tests, whereas a partial exam will cover only a few tests identified as key. A diagnostic procedure will seek to identify a specific disease or condition, often uncovered during a routine eye exam. 
Thanks to the AHCIP, up to 3 visits to the optometrist are covered during the benefit year, anytime from July 1 to June 30. To keep track of the benefit year, you’ll have to remember these dates, and you might try using them to your family’s advantage.
For example, if an optometrist advised that your child needs 2 full diagnostic procedures within 3 months, you might schedule one diagnostic between June 1st and June 30th of a given year, and one diagnostic between July and September of the same year.

Claiming Benefits with your Child’s Eye Exam

One advantage of living in Alberta brings to families is that optometrists bill for services covered by AHCIP directly to Alberta Health, rather than billing patients. Some ocular conditions warrant full coverage by the AHCIP, as long as an optometrist considers it medically necessary like in the case of eye injury or a medical condition that affects the eyes (like diabetes).
On the other hand, a child’s parent or guardian is responsible for additional expenses like contact lenses or glasses that come with the visit. You might have additional coverage through a private insurer, but each policy is different. 
If you have additional private insurance, you might have additional coverage past exceeded AHCIP benefits, but it’s best to gather information on exact coverage for each type of visit from your insurer before you bring your child.
Bring your child’s Alberta Health Care Card and confirm with your vision care provider ahead of the exam what will be covered. You can contact the AHCIP office if you have further questions about the Alberta Health Care Insurance Plan. 
Vision and learning are intimately connected, and you can optimize your children’s future by keeping a watchful eye on their ocular health. Within Alberta, there is coverage to help families ensure their child’s eye health.

Written by Dr. Rod Adams

Dr. Rod Adams is a graduate of the University of Alberta and the University of California at Berkeley School of Optometry. Dr. Adams has been in private family practice since 1997. During this time, he has developed a strong interest in pediatric optometry and laser corrective surgery options.
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