Discovery Medical Aid mistake to cost some of its customers thousands

Several Discovery Health clients are facing unexpected financial pressure after the insurer acknowledged an error in processing medicine claims between January and December 2025.

As a result, affected members have been informed that they are required to repay amounts incorrectly paid out during this period.

According to a letter received by some Discovery clients, a system error was identified, affecting the way that certain prescription and over-the-counter medicines were processed in 2025.

Because of this error, certain claims were counted toward and paid from the Above Threshold Benefit at a higher rate than allowed by the benefits, Discovery Health COO Karen Sanderson informed affected clients in a letter.

This means that, instead of medicine claims being accumulated and paid at the usual percentages, such as 0% for over-the-counter medicine, 50% for high-cost, non-preferred medicine, Discovery processed all claims at 100% of the Discovery Health Rate. 

It said that some of its clients therefore reached the threshold for medicine claims earlier than expected, and claims made after the threshold was reached were paid for by Discovery, even though they should have been paid from the customer’s Medical Savings Account (MSA).

Discovery reprocessed the affected claims. Some of these claims required a co-payment at the time of claiming, which Discovery incorrectly covered. 

“This means you owe the scheme the value of these 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,” Sanderson said in the letter to affected clients. 

According to a statement by the insurer, this affected 0.6% of Discovery clients, who received more cover from the scheme than they qualified for. 

“We need to correct this error to ensure that the benefits you received between January and December are in line with the Scheme rules,” Sanderson said. 

As of late 2024/early 2025, Discovery Health Medical Scheme had approximately 1.36 million principal members, covering over 2.73 million beneficiaries.

This means that thousands of clients would have received the news that they needed to pay back the insurer.

Affected customers will receive a statement detailing how much they owe, and Discovery said it will arrange payment plans that work for each customer’s circumstances.

“We realise this correction, due to an error we made, wasn’t part of your planning and may cause significant frustration and inconvenience. We apologise for this error and the inconvenience this may cause,” Sanderson said.

Discovery said that claims have now been corrected, impacted members are “proactively being supported”, and “stronger controls are in place to prevent this from happening again.”

Premiums already set to increase

The letter has been circulated online, with affected customers sharing their frustration that they have been told to repay tens of thousands.

One client commented on Facebook: “I apparently owe 37k. Where do they expect us to find this money with their increase coming?”

The error comes after Discovery announced it will increase medical aid premiums by up to 7.9% in 2026, with increases effective from April. 

The weighted average increase for members will be 7.2%, while members of the KeyCare, Executive, Comprehensive and Coastal plans will see 7.9% increases in 2026. 

Premiums for all other plans will increase by 6.9%, representing about two-thirds of all beneficiaries. The weighted increase of 7.2% is far above the current inflation rate of 3.3%.

When Discovery announced the increase, it said it was able to hold off the hike in fees until April because of the scheme’s positive solvency position.

It said it was committed to providing customers financial relief, and was in a position to do so without compromising its long-term sustainability.