Discovery Health says it has reprocessed claims on its Discovery Health Medical Scheme (DHMS) after a processing error resulted in claims being incorrectly paid out at a higher rate than the plan’s benefits allow. The claims were initially processed between January and December 2025. Theerror relates to the Above Threshold Benefit (ATB) on the Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority, and Essential Priority plans, which affected howcertain prescription and over-the-counter medicines were processed in 2025.
“Because of this error, certain of your claims were counted toward and paid from the Above Threshold Benefit (ATB) at a higher rate than what the benefits allow,” Discovery Health COO Karen Sanderson informed affected clients in a letter seen byThe Citizen. Discovery reprocessed the affected claims, with some requiring a co-payment at the time of claiming, which Discovery incorrectly covered. In the communication, members owe the scheme between R22 000 and R37 000.
In a statement toThe Citizen, Discovery Health said it identified and resolved a system error that affected how certain medication claims for DHMS members in 2025 were funded. “While only a small proportion of scheme members were impacted, we sincerely apologise for the inconvenience caused. All affected claims have been corrected, members are receiving proactive support, and stronger controls have been implemented to prevent a recurrence.” Discovery Health said that “in the interests of ensuring integrity of the scheme rules and treating all members of the scheme fairly, the scheme is obligated to recover funds where members have inadvertently received disproportionate benefits that they unfortunately weren’t entitled to”. “All recoveries are being managed strictly in accordance with the Medical Schemes Act, Council for Medical Scheme rules and regulations, and DHMS’ Rules 15.5 and 16.4.”
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