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Discovery Health has sent communication to a number of members requesting them to repay Discovery Health Medical Scheme (DHMS) after a processing error saw claims incorrectly paid out at a higher rate than their plan\u2019s benefits allow.<\/p>\n
The error is related to the Above Threshold Benefit (ATB) on the Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority and Essential Priority plans.<\/p>\n
Read:
Discovery Health Medical Scheme member loss continues
Discovery execs, directors in share sales totalling R99m<\/p>\n
Day-to-day expenses are paid from the ATB once the member has reached their annual threshold. However, the ATB itself has limits \u2013 and when these were reached, Discovery Health paid for subsequent claims even though these claims should have either been paid from a member\u2019s medical savings account (MSA) or funded by the member.<\/p>\n
Discovery Health won\u2019t disclose the number of impacted members or the quantum of the total amount owed but says a \u201csmall proportion of scheme members\u201d and \u201conly certain members\u201d on the five plans were affected.<\/p>\n
The two largest affected plans (Classic Comprehensive and Classic Priority) had an average number of members of 91 370 and 67 353 in 2024 respectively. When it comes to beneficiaries, the average was 183 863 and 144 481 respectively.<\/p>\n
The three other plans are far smaller with average members of 7 260 (Executive), 4 667 (Essential Priority) and 3 157 (Classic Smart Comprehensive).<\/p>\n
Moneyweb understands that the number of impacted members is less than 1% of the DHMS scheme (which has 1.35 million members and 2.7 million beneficiaries).<\/p>\n
Read: Discovery forecasts up to 32% jump in annual earnings<\/p>\n
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As the contracted administrator of DHMS, Discovery Health has reprocessed these claims (originally\u00a0processed between January and December 2025) correctly and has been in touch with affected members.<\/p>\n
\u2018You now owe the scheme\u2019<\/strong><\/p>\n In these letters, Discovery Health says: \u201cWhen we reprocessed these claims, some would have incurred a co-payment at the time of claiming but did not because of the error.<\/p>\n \u201cThis means you now owe the scheme the value of those co-payments, as well as any claims that were paid by the scheme but should have been paid by you during your self-payment gap.\u201d<\/p>\n Moneyweb has seen communication to members where they owe the scheme as much as R22 000, R25 000 and R37 000.<\/p>\n<\/blockquote>\n At current rates (contributions for 2026 have been frozen at 2025 levels until 31 March), contributions for a main member on Classic Comprehensive and Classic Priority total R83 700 and R52 176 respectively.<\/p>\n Read: Discovery to hike top, low-end medical aid plans by 7.9% in 2026<\/p>\n Affected members have received statements showing the amount they owe the scheme.<\/p>\n Discovery says: \u201cWe\u2019ll contact you to arrange a payment plan that works for your circumstances as you will need to repay this amount back to the scheme\u201d \u2026 and that it is \u201ccommitted to working with you to agree a repayment plan that works for you and the scheme.\u201d<\/p>\n Discovery Health says it recognises \u201cthat unexpected adjustments can affect personal budgets and planning\u201d.<\/p>\n ADVERTISEMENT:<\/p>\n CONTINUE READING BELOW<\/p>\n<\/div>\n<\/div>\n<\/blockquote>\n It says that \u201cin the interests of ensuring integrity of the scheme rules and treating all members of the scheme fairly, the scheme is obligated to recover funds where members have inadvertently received disproportionate benefits that they unfortunately weren\u2019t entitled to\u201d.<\/p>\n \u201cAll recoveries are being managed strictly in accordance with the Medical Schemes Act, Council for Medical Scheme rules and regulations, and DHMS\u2019 Rules 15.5 and 16.4.\u201d<\/p>\n According to Rule 15.5, \u201cif the scheme, for any reason, pays an amount more than which it is liable to pay for a claim, then the scheme can recover this through payments due to the member\u201d.<\/p>\n \u201cAdditionally, Rule 16.4 states that when the scheme has paid an account, or portion of an account, or any benefit that a member is not entitled to, the amount of such overpayment is recoverable by the scheme.\u201d<\/p>\n Read: Top 10 Discovery medical claims paid in 2024 totalled R70m<\/p>\n It adds that members\u2019 2026 medical benefits and medical aid cover and access \u201care entirely unaffected by this error\u201d and no healthcare providers have been negatively impacted. The latter would be obvious as all claims were paid.<\/p>\n Discovery Health says \u201cstronger controls have been implemented to prevent a recurrence\u201d and that \u201cclaims processing systems are functioning entirely correctly\u201d.<\/p>\n Discovery share price<\/strong><\/p>\n Follow Moneyweb\u2019s in-depth finance and business news on WhatsApp here.<\/em><\/p>\n<\/p><\/div>\n\n
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