Discovery Health to cover costs of recent claims system error affecting thousands of clients
FULL REFUND
Discovery Health has announced it will bear the cost of mistakes its administrator made when processing the claims of members.
Image: File
Discovery Health clients can finally breathe a sigh of relief following the announcement that the medical scheme will cover the costs related to a claims system error that caused significant distress among its members last week. On Sunday, Discovery Health confirmed that those affected by the glitch — resulting in the overpayment of specific Above Threshold Benefit (ATB) claims during 2025 — will not be required to repay any amounts linked to this error.
The medical scheme disclosed that the issue impacted a limited number of members, specifically those whose ATB claims were inadvertently overpaid over the past year. This said, the scale of the discrepancy was not massive in context; it affected 16,507 members across several Executive, Comprehensive and Priority plans, representing approximately 10.5% of members enrolled in those specific categories. However, the overall impact on Discovery’s total membership amounts to less than 0.6%.
“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 Discovery CEO Ron Whelan. He added, “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.”
The medical aid provider revealed that it would update claim statements for affected members, ensuring transparency and accuracy moving forward. Additionally, any deductions that had been made to Medical Savings Accounts, Personal Health Fund or HealthPay accounts due to the erroneous claims will be reinstated. Members who had already repaid the incorrectly funded amounts will also receive a full refund.
To further assist those impacted, Discovery Health has established a dedicated service team tasked with contacting affected members directly. This team will address any outstanding queries and provide necessary clarity regarding the situation, ensuring that all concerns are managed satisfactorily.
Last week, reports emerged, including some on social media, detailing that certain members were unexpectedly asked to repay amounts reaching up to R35,000, leading to public discontent. Many members expressed their frustration, deeming it unjust to shoulder unexpected costs stemming from a system error attributable to the medical aid provider.
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