Good news for Discovery medical aid members told to pay back thousands in claims
Discovery Health announced that it will cover the cost of a claims system error that resulted in the overpayment of certain Above Threshold Benefit (ATB) claims during 2025.
Thousands of Discovery Health clients were hit with a notice from the group in January, alerting them to an error in processing medicine claims between January and December 2025.
Because of the error, claims were paid out to members above the proper threshold, and as a result, the health group said it would be moving to reclaim the overpayments.
This meant that members would have to pay the money back to Discovery, amounting to thousands of rands each.
However, following public backlash, Discovery has opted to cover the overpayment on behalf of the members.
“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,” it said.
With Discovery Health absorbing the full cost, neither the Scheme nor any members are negatively impacted in any way.
Discovery had previously maintained that, in terms of the country’s regulations, a medical scheme is entitled to recover any amounts overpaid to members.
This is to ensure the financial stability of such schemes. Discovery said that this remains valid, but it is taking a different approach.
“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 Dr Ron Whelan, CEO of 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,” the group 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.
A dedicated service team will contact affected members directly to address outstanding queries and provide clarity, it said.
“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,” Whelan said.
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