Discovery Health has reversed its decision to recover thousands of rands from members following a 2025 claims processing error—confirming that affected Discovery Health Medical Scheme (DHMS) members will not have to pay anything back.
The error occurred in the processing of medicine claims between January and December 2025 on certain Executive, Comprehensive and Priority plans. Due to a system fault, some Above Threshold Benefit (ATB) claims were incorrectly paid at 100% of the Discovery Health Rate, instead of the lower percentages that normally apply.
When Discovery initially notified members, many were told they owed significant amounts. The move sparked public backlash and concern across social media and consumer platforms. After reviewing the impact on members, the scheme has now opted to absorb the full cost.
“Affected Discovery Health Medical Scheme members will not be required to repay any amounts related to the error, and no other members of the Scheme will be disadvantaged because of this decision,” the group said.
CEO Dr Ron Whelan added:
“Having carefully listened to members’ concerns and considered their individual experiences and circumstances, Discovery Health has decided to cover the cost on members’ behalf.”
Who was affected?
- 16,507 members on certain Executive, Comprehensive and Priority plans
- This equals 10.5% of members on those plans
- Less than 0.6% of the scheme’s total membership
- Members outside this group are not impacted
- 2026 benefits remain unchanged across all plans
What happens now?
- Claims statements will be updated to reflect the reversal
- Any deductions from Medical Savings Accounts, Personal Health Fund or HealthPay will be reinstated
- Members who already repaid amounts will be refunded in full
- A dedicated service team will contact affected members directly
Discovery previously argued that medical schemes are entitled under regulation to recover overpayments to protect financial stability—an approach reflected in other disputes, including Discovery Health’s Road Accident Fund case. While that position remains legally valid, the scheme says this situation required a different response.
Understanding ATB
An Above Threshold Benefit (ATB) is a safety net on certain plans. Once your Medical Savings Account is depleted and you reach your annual threshold, ATB kicks in to help cover day-to-day medical expenses at defined rates. Discovery’s own explanation is available here:
Discovery Health’s Above Threshold Benefit (ATB) explained
In this case, claims that should have been paid at 0%, 50% or 75% were mistakenly processed at 100%, triggering the repayment notices.
What this means for members
- You owe nothing for this error
- Your savings and benefits are restored
- There is no knock-on impact to 2026 benefits
- Discovery says it is strengthening controls to prevent a repeat
Dr Whelan concluded:
“We apologise unreservedly to members affected by this error. Covering this cost is the right decision, one that reflects our commitment to fairness, integrity and putting members first.”
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