Overview
- Discovery reprocessed 2025 medicine claims that were incorrectly funded at 100% of the Discovery Health Rate from the Above Threshold Benefit on five DHMS plans.
- Individual members have been told they owe roughly R22,000 to R37,000, reflecting co-payments and self-payment gap amounts that should have applied.
- Discovery says only a small proportion of members were affected, all impacted claims are corrected, and additional controls have been implemented to prevent a recurrence.
- The company says 2026 medical benefits and access remain unaffected and no healthcare providers were negatively impacted.
- Affected members are receiving statements and will be contacted to arrange payment plans, with recoveries managed under the Medical Schemes Act and DHMS Rules 15.5 and 16.4; some members have signaled complaints to the Council for Medical Schemes.