Private health insurance for heart procedures — what you need to know in Victoria
A plain-English guide to Silver and Gold hospital cover, waiting periods, known-gap arrangements and how to avoid out-of-pocket surprises.
Private health insurance in Australia can feel deliberately confusing. Here's what actually matters when you need complex coronary intervention.
You need Silver or Gold hospital cover — with the right clinical category
Coronary stenting sits under the Heart and vascular system clinical category. Basic and Bronze policies almost never include it. Silver and Gold policies almost always do — but check your policy schedule or call your fund and ask specifically about MBS item numbers 38306 and 38318.
Waiting periods
Standard waiting period is 12 months for pre-existing conditions. If you've held equivalent or higher cover continuously (even across funds), you generally don't restart the clock.
Known-gap and no-gap
We work with all major funds — Medibank, Bupa, HCF, NIB, AHM, HBF and others — and offer known-gap arrangements where possible. Before your procedure you'll receive an itemised written estimate covering the specialist fee, anaesthetist, assistant, hospital and any device gap. There should be no surprises.
What is not covered
Consultations in our rooms fall under Medicare, not your hospital cover — you'll typically pay a gap of $80–$150 depending on the visit. Cardiac imaging done as an outpatient is also billed separately.