Discovery Health members face financial shock due to medical aid error
Discovery Health Medical Scheme members are starting the new year with a financial shock
Image: File
Discovery Health Medical Scheme members are starting the new year with a financial shock, after being told they must repay thousands of rands following a claims processing error in 2025.
This comes after the scheme discovered that certain prescription and over-the-counter medicine claims on five top plans – including Classic Comprehensive, Classic Priority, and Executive – were incorrectly paid at higher rates than allowed.
The error meant members reached their annual Above Threshold Benefit (ATB) sooner than expected, with certain claims incorrectly funded from the ATB during 2025. These claims have since been reprocessed to be funded from the correct benefits, such as Medical Savings Accounts or the Self-Payment Gap.
Some members of the scheme have taken to X (formerly Twitter), revealing that they were shocked to learn they now owe tens of thousands of rands, with one user saying the average amount being requested is around R35,000.
According to reports, the two largest affected plans include Classic Comprehensive and Classic Priority, which together cover more than 158,000 members and over 327,000 beneficiaries.
"So many friends getting calls from @Discovery_SA today to tell them the fund has overpaid their pharmacies and that they are now liable ... average is like R35k. Has @Discovery_SA commented on this? Sounds like a right royal screw up," X user @HowardFeldman said.
Discovery Health confirmed to IOL that only a small proportion of members were affected and that all impacted claims have been corrected and reprocessed. The scheme emphasised that members’ 2026 medical benefits and access to healthcare are entirely unaffected.
"To ensure benefits align with Scheme Rules and regulatory requirements, all impacted claims have been reprocessed so that they are funded from the correct benefits, either Medical Savings Accounts or the Self-Payment Gap. The claims processing systems are functioning entirely correctly, and additional safeguards and validation checks have been introduced to prevent similar issues in future.
"The Scheme has also commenced a recovery process for over-funded amounts, ensuring fairness, consistency, and regulatory compliance across the Scheme. We recognise that unexpected adjustments can affect personal budgets and planning, and we are working closely with each affected member to manage this in the most appropriate and supportive way."
The company added that affected members will receive detailed statements and support, including repayment plans tailored to individual circumstances.
"We deeply regret this error and sincerely apologise for the frustration this has caused. Discovery Health and DHMS take this incident extremely seriously and remain committed to earning and maintaining members’ trust through strong operational discipline, robust controls and oversight, and transparent communication with ongoing support for all affected members," a company spokesperson added.
mthobisi.nozulela@iol.co.za
IOL Business