A processing error has led to Discovery Health members being asked to repay money after their claims were incorrectly paid out at a higher rate than their plan’s benefits allow.
The mistake is related to the Above Threshold Benefit (ATB) on the Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority and Essential Priority plans, reports Moneyweb.
Day-to-day expenses are paid from the ATB once the member has reached their annual threshold. However, the ATB itself has limits – and when these were reached, Discovery Health paid for subsequent claims even though these claims should have either been paid from a member’s medical savings account (MSA) or funded by the member.
Discovery Health won’t disclose the number of affected members or total amount owed but says a “small proportion of scheme members” and “only certain members” on the five plans were affected.
The two largest affected plans (Classic Comprehensive and Classic Priority) had an average number of members of 91 370 and 67 353 in 2024 respectively. When it comes to beneficiaries, the average was 183 863 and 144 481 respectively.
The three other plans are far smaller with average members of 7 260 (Executive), 4 667 (Essential Priority) and 3 157 (Classic Smart Comprehensive).
Moneyweb understands that the number of impacted members is less than 1% of the DHMS scheme (which has 1.35m members and 2.7m beneficiaries).
As the contracted administrator of DHMS, Discovery Health has reprocessed these claims (originally processed between January and December 2025) correctly and been in touch with affected members.
Moneyweb has seen communication to members where they owe the scheme as much as R22 000, R25 000 and R37 000.
Discovery Health says it recognises “that unexpected adjustments can affect personal budgets and planning”.
“Stronger controls have been implemented to prevent a recurrence,” it added.
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