When Discovery discovered its processing mistake, it emailed members to inform them of their debt, which is estimated to be R20 000 on average.
In a dramatic about-turn, Discovery Health announced it will cover the costs of claims overpayments, remedying its year-long pharmacy medication claims funding error, resulting in the scheme paying more than 16 000 members more than what they were entitled to.
2026 got off to a financially challenging start for millions of Discovery Medical Aid members, who were initially told to fork out thousands of rands for an error in processing medicine claims for the entire 2025 year.
Headache
The error related to the Above Threshold Benefit (ATB) on the Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority, and Essential Priority plans; which affected how certain prescription and over-the-counter medicines were processed in 2025.
Discovery reprocessed the affected claims, with some requiring a co-payment at the time of claiming, which Discovery incorrectly covered.
The claims were initially processed between January and December 2025.
Pressure
After pressure from members and protests at its offices in Sandton, Discovery has had a change of heart and will now cough up the money to cover the cost of a claims system error that resulted in the overpayment of what it called “certain ATB claims” during 2025.
“Affected Discovery Health Medical Scheme members will not be required to repay any amounts related to the error, and no other members of the Scheme will be disadvantaged because of this decision,” said Dr Ron Whelan, CEO of Discovery Health, on Sunday, to the schemes 16 507 members who were affected by the error.
“The error affected a limited group of members whose ATB claims were inadvertently overpaid during 2025. With Discovery Health absorbing the full cost, neither the Scheme nor any members are negatively impacted in any way.
How many affected?
Whelan said, notwithstanding the validity of the recovery, “having carefully listened to members’ concerns” and considered their individual experiences and circumstances, the scheme 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.”
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Impact
Discovery, for the first time, revealed the exact number of members affected by the error.
Wheelan said the affected group represents 10.5% of the members on those plans, and less than 0.6% of the Scheme’s total membership.
He said there is no impact on members outside this group, and benefits for 2026 across all plans “remain completely unaffected.”
“For affected members, claims statements will be updated to reflect this decision. Any deductions made to Medical Savings Accounts, Personal Health Fund or HealthPay accounts will be reinstated, and members who have already repaid amounts will be refunded in full.
“A dedicated service team will contact affected members directly to address outstanding queries and provide clarity,” Wheelan said.
Apology
Wheelan apologised to members.
“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.”
Frustrations
Mark Hyman, CEO and founder of MediCheck, a company which assists medical aid members with claims disputes, advised affected members to reserve the right to approach a “competent court for urgent interdictory relief (standstill), declaratory relief regarding the unlawfulness of set‑off and debt demands absent proof, and costs orders as the court deems fit.”
Discovery members took to social media to vent their frustrations about repaying the money, with many already bearing the burden of paying for school uniforms and stationery for their children ahead of the 2026 school academic year.
How much money
While Discovery did not reveal the exact amount of the overpayments to members, Hyman believed it was less than R180 million.
In a communication to members, Discovery said members owed the scheme between R22 000 and R37 000.
Discovery said members’ 2026 benefits won’t be affected.
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