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Eye Care

Eye exam including supplies and procedures required for this exam and the following items prescribed by an optometrist or an ophthalmologist may be reimbursed:

  • Corrective glasses;
  • Prescribed corneal lenses;
  • Prescribed disposable lenses;
  • Frames;
  • Prescribed sunglasses (corrective glasses);
  • Flexible intra-ocular lens implants (for cataracts) excluding costs of surgery (see paragraph Surgical Vision Correction);
  • Prescribed half-readers;
  • Prescribed reading glasses;
  • Fresnel prisms;
  • Prescription safety eyeglasses.

Among the non-reimbursable items are:

  • All glasses that are not prescribed or adjusted to the vision (sunglasses, reading glasses, security goggles, etc.);
  • Products or solutions related to the use of lenses;
  • Sun clips;
  • Magnifying lamp;
  • Glasses for photophobia.

Limitations to reimbursement

The Bulletin MÉDIC Construction for each plan lists the reimbursable amounts. It is important to check the plan under which the insured is covered, since some insurance plans do not offer eye-care coverage.

For an eye exam, the maximum reimbursable amount is calculated on a period of 12 consecutive months from the date of full payment for this exam (see example below).

Only insured employees may obtain reimbursement for the purchase of safety glasses. The maximum reimbursable amount is calculated on a period of 12 consecutive months from the date of purchase. The date of purchase is the date of the invoice indicating that final payment was made - that is, that the balance to pay is $0.

For the reimbursement of other eligible costs (glasses, contact lenses, prisms, etc.), the maximum reimbursable amount is calculated on a fixed time period. For workers and their spouses, this period is 24 months; for dependent children, the period is 12 months. This period starts from the date of purchase. The date of purchase is the date of the invoice indicating that the final payment has been made – that is, that the balance is $0.

The example below illustrates how the calculation is done.

Mr. Jones purchases glasses and pays the total amount of the invoice for $300 on August 15, 2017. During the insurance period from July to December 2017, his insurance plan covers $450 per 24-month period for the purchase of glasses and $70 vision exams per 12-month period. The table below shows the costs claimed by Mr. Jones and the reimbursements that he obtained.

Date of purchase Eye care Cost claimed Reimbursement obtained
August 22, 2015 Purchase of glasses $250 $250
July 29, 2016 Vision exam $70 $70
August 3, 2017 Vision exam $70 $70
August 15, 2017 Purchase of glasses $300 $200

Why did Mr. Jones not receive full reimbursement for his purchase of glasses on August 15, 2017?

Mr. Jones’ reimbursements for the purchase of glasses are calculated over 24-month period - thus the period from August 16, 2015, to August 15, 2017.  Since Mr. Jones already obtained $250 in reimbursements (for his purchase of August 22, 2015), only $200 is available to reach the maximum of $450 payable during this period ($450 - $250 = $200).

To obtain a better reimbursement, Mr. Jones should have waited until August 22, 2017 to purchase his glasses. In this case, the 24-month period would have gone from August 23, 2015, to August 22, 2017. Since Mr. Jones had not made any claim for reimbursement of glasses during this period, $450 would have been available to reimburse his purchase. Mr. Jones would therefore have received full reimbursement for his $300 purchase, instead of only $200.

On the other hand, Mr. Jones received full reimbursement for his claim of August 3, 2017 because he had not been reimbursed for an eye exam during the period from August 4, 2016 to August 3, 2017.

Surgical vision correction

Some plans provide specific lifetime amounts for the reimbursement for cost of surgical vision correction, by either laser or incision. However, these amounts exclude the cost of intraocular lenses, which is reimbursable under the coverage in your plan for purchases of glasses and lenses. The Bulletin MÉDIC Construction contains this information.

Reimbursement of costs

Claims for eye care must be made using the Health and Professional Care Claim Form.

Specific conditions, limitations, and exclusions other than those mentioned above may apply to the reimbursement of certain types of coverage; only the Règlement sur les régimes complémentaires d'avantages sociaux dans l'industrie de la construction has legal value.

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