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Following an outcry from affected members and mounting pressure, Discovery Health announced on Sunday that it will the cover costs of claims overpayments to protect members of Discovery Health Medical Scheme (DHMS).<\/p>\n
\u201cDiscovery Health \u2026 \u00a0will cover the cost of a claims system error that resulted in the overpayment of certain Above Threshold Benefit [ATB] claims during 2025. Affected DHMS members will not\u00a0be required\u00a0to repay any amounts related to the error, and no other members of the Scheme will be disadvantaged because of this decision,\u201d it said in a statement<\/p>\n
Read:<\/p>\n
\u201cThe error affected a limited group of members whose ATB claims were inadvertently overpaid during 2025. With Discovery Health absorbing the full cost, neither the Scheme nor any members are negatively\u00a0impacted\u00a0in any way,\u201d it reiterated.<\/p>\n
\u201cNotwithstanding the validity of the recovery, having carefully listened to members\u2019 concerns and considered their individual experiences and circumstances, Discovery Health has decided to cover the cost on members\u2019 behalf,\u201d said Discovery Health CEO Dr Ron Whelan.<\/p>\n
According to Discovery Health, the error affected 16 507 members across certain Executive, Comprehensive and Priority plans where ATB applies.<\/p>\n
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\u201cThe affected group\u00a0represents\u00a010.5% of the members on those plans, and less than 0.6% of the Scheme\u2019s total membership. There is no impact on members outside this group, and benefits for 2026 across all plans\u00a0remain\u00a0completely unaffected,\u201d it said.<\/p>\n
Read: Discovery Health asks members to repay thousands after claims processing error<\/p>\n
\u201cFor affected members, claims statements will be updated to reflect this decision. Any deductions made to Medical Savings Accounts, Personal Health Fund or\u00a0HealthPay\u00a0accounts will be reinstated, and members who have already repaid amounts will be refunded in full,\u201d the group added.<\/p>\n
Discovery Health said that a dedicated service team will contact affected members directly to address outstanding queries and provide clarity.<\/p>\n
Apology<\/strong><\/p>\n Dr Whelan apologised for the debacle.<\/p>\n \u201cWe apologise unreservedly to members affected by this error.<\/p>\n ADVERTISEMENT:<\/p>\n CONTINUE READING BELOW<\/p>\n<\/div>\n<\/div>\n \u201cCovering this cost is the right decision, one that reflects our commitment to fairness, integrity and putting members first, especially when we fall short.\u201d<\/p>\n DHMS?is a non-profit entity that belongs to its members and is overseen by an independent Board of Trustees. DHMS outsources its administration and managed care functions to Discovery Health through a formal contractual arrangement.<\/p>\n As?background,?late?in 2025 Discovery Health?identified?a claims system error that affected the processing of ATB medicine claims for?some?Discovery?Health Medical Scheme members on Executive, Comprehensive, and Priority plans.<\/p>\n As a result of the error, ATB benefits for these members accumulated at higher rates, leading to the Scheme funding certain medicines and services that ought to have been paid for by members.<\/p>\n \u00a0<\/p>\n Follow Moneyweb\u2019s in-depth finance and business news on WhatsApp here.<\/em><\/p>\n<\/p><\/div>\n