Discovery Health has asked a number of members to repay the Discovery Health Medical Scheme (DHMS) after a processing error resulted in some claims being paid at higher rates than allowed by members’ benefit plans.
According to the health scheme, the error relates to the Above Threshold Benefit (ATB) on five plans Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority and Essential Priority.
Once members reach their annual threshold, certain day-to-day expenses are paid from the ATB.
Claims incorrectly paid
However, the ATB itself has limits.
Discovery Health said after these limits were reached, some claims were incorrectly paid by the scheme. These should have been paid from members’ medical savings accounts (MSAs), or funded by members themselves.
Discovery Health has not disclosed how many members were affected or the total amount involved. It said only certain members on the five plans were impacted.
The two largest plans involved, Classic Comprehensive and Classic Priority, had average member counts of 91, 370 and 67, 353 in 2024.
As the contracted administrator of DHMS, Discovery Health said it has reprocessed the affected claims. These were originally handled between January and December 2025, and it has contacted impacted members.
“When we reprocessed these claims, some would have incurred a co-payment at the time of claiming. But they did not, because of the error.
Members’ benefits not affected
“This means you now owe the scheme the value of those co-payments. As well as any claims that were paid by the scheme but should have been paid by you during your self-payment gap,” said discovery in the letters sent to the members.
Affected members have received statements detailing what they owe.
Discovery Health says members’ 2026 benefits and medical aid cover are unaffected. No healthcare providers were negatively impacted. And stronger controls have been implemented to prevent a recurrence.
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