Discovery Health now takes full financial responsibility for medical scheme error
Discovery Health will cover the costs incurred following an error that led to the overpayment of certain Discovery Health Medical Scheme (DHMS) Above Threshold Benefit (ATB) claims in 2025. This follows a letter sent to affected members last week, requesting repayment.
In a statement, Discovery Health says that affected DHMS members will not be required to repay any amounts related to the error.
It also indicates that other members of the scheme will remain unaffected.
The error affected a limited group of members whose ATB claims were overpaid during 2025.
“With Discovery Health absorbing the full cost, neither the scheme nor any members are negatively impacted in any way,” says the statement.
Dr Ron Whelan, CEO of Discovery Health, says: "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."
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.
Discovery states that there is no impact on members outside this group, and benefits for 2026 across all plans remain unchanged.
The claims statements of the affected members will be updated to reflect Discovery’s decision.
Furthermore, any deductions from the affected members’ Medical Savings Accounts, Personal Health Fund, or HealthPay accounts will be reinstated.
Those who have already repaid amounts will be refunded in full.
Discovery added that a dedicated service team will contact affected members directly to address outstanding queries and provide clarity.
MediCheck — an independent medical scheme advocacy firm that assists members in disputes with medical schemes — welcomed Discovery Health's announcement.
"We welcome Discovery Health's decision to do the right thing and absorb the cost of their own error," said Mark Hyman, CEO of MediCheck.
MediCheck represented more than 1,500 affected members and estimates that disputed recoveries are between R130m and R170m, based on the number of affected members and the range of individual recovery amounts reported.
"Our members were facing significant financial pressure over an issue that was entirely outside their control, which is why we lodged the issue with the Council for Medical Schemes," adds Hyman.
Hyman believes that this case highlights medical scheme governance and administration controls.
"Under the Medical Schemes Act, the board of trustees is responsible for ensuring proper control systems.
"When a systemic error of this magnitude occurs across an entire benefit year, members deserve answers about what went wrong and what safeguards are now in place," says Hyman.