By Suren Naidoo.
Following an outcry from affected members and mounting pressure, Discovery Health announced on Sunday that it will cover the costs of claims overpayments to protect members of the Discovery Health Medical Scheme (DHMS).
“Discovery Health … will 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 be required to repay any amounts related to the error, and no other members of the Scheme will be disadvantaged because of this decision, “it said in a statement
Late in 2025 Discovery Health identified a claims system error that affected the processing of ATB medicine claims for some DHMS members on Executive, Comprehensive, and Priority plans.
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.
“The 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 impacted in any way,” it reiterated.
“Notwithstanding the validity of the recovery, having carefully listened to members’ concerns and considered their individual experiences and circumstances, Discovery Health has decided to cover the cost on members’ behalf, “said Discovery Health CEO Dr Ron Whelan.
According to Discovery Health, the error affected 16 507 members across certain Executive, Comprehensive and Priority plans where ATB applies.
“The affected group represents 10.5% of the members on those plans, and less than 0.6% of the Scheme’s total membership. There is no impact on members outside this group, and benefits for 2026 across all plans remain completely unaffected,” it said.
“For affected members, claims statements will be updated to reflect this decision. Any deductions made to Medical Savings Accounts, Personal Health Fund or HealthPay accounts will be reinstated, and members who have already repaid amounts will be refunded in full,” the group added.
Discovery Health said that a dedicated service team will contact affected members directly to address outstanding queries and provide clarity.
Apology
Dr Whelan apologised for the debacle. 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, especially when we fall short,” he said.
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.