Backlash forces Discovery medical aid to cover costs of claims mistake

Following backlash from Medical Aid members, Discovery Health has announced it will cover the costs of a year-long claims error that resulted in the overpayment of certain claims in 2025. 

Affected members on Executive, Comprehensive and Priority Plans were informed in December 2025 that they are required to repay amounts incorrectly paid out during the year.

Members were told to repay thousands, resulting in backlash from those affected. On 11 January, however, Discovery Health backtracked on its previous messages to clients and announced that the scheme will cover the costs of the mistake. 

This means that the affected members will no longer be required to repay any amounts related to this error.

“Ordinarily, when members’ claims are overpaid, the Scheme’s rules and industry legislation allow those funds to be recovered, because the funds in the Scheme belong to all members,” Discovery Health said. 

However, after listening to client concerns, Discovery Health has decided to cover the cost of the error. 

Despite covering the cost of the error, Discovery has promised that no other members will be affected, and benefits for 2026 across all plans will remain the same. 

“The claims statements of affected members are being updated, and our dedicated service team is contacting them to resolve any outstanding queries,” Discovery said. 

“Discovery Health apologises unreservedly to members affected by this error. We believe it is the right decision to cover this cost, it reflects our commitment to fairness, integrity and putting members first, especially when we fall short.”

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.

Members previously told to repay thousands

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).

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

0.6% of Discovery clients received more coverage from the scheme than they qualified for. 

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.

The error occurred after Discovery announced that it would increase medical aid premiums by up to 7.9% in 2026, with the 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.