Discovery Health Requests Repayment After 2025 Medical Claims Processing Error

Discovery Health Requests Repayment After 2025 Medical Claims Processing Error. Discovery Health Medical Scheme (DHMS) has begun contacting affected members following a claims processing error that occurred during 2025, requesting the return of funds that were incorrectly paid out.

In a letter sent to members, Discovery Health stated that the error affected the processing of claims for prescription and over-the-counter (OTC) medicines between January and December 2025. According to Moneyweb, the affected plans include Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority and Essential Priority.

The scheme explained that, due to the error, certain claims were incorrectly allocated to and paid from the Above Threshold Benefit (ATB) at a higher rate than permitted under scheme rules. Under normal circumstances, OTC medicines are paid at 0 percent of the Discovery Health Rate (DHR), high-cost non-preferred medicines at 50 percent, and certain non-generic medicines at 75 percent. However, during the affected period, these claims were processed and accumulated at 100 percent of the DHR.

Discovery Health said that when the claims were reprocessed, it became clear that some should have resulted in co-payments at the time of claiming. Because the error prevented this, members are now being asked to reimburse the scheme for those co-payments, as well as for claims that should have been paid during self-payment gaps.

In its correspondence, the scheme stated that members received more cover than they were entitled to and that the corrections are necessary to align benefits with scheme rules. Discovery Health apologised for the error and the frustration caused, adding that it is providing support to affected members and strengthening internal controls to prevent a recurrence.

The issue has drawn public reaction, with affected members expressing concerns on social media. Medical claims assistance company Medicheck has since created a dedicated email address to help members review the correspondence. Medicheck has also advised members not to sign acknowledgements of debt or enter into payment arrangements until the matter is reviewed by the Council of Medical Schemes’ Fraud, Waste and Abuse Advisory body.

Discovery Health said all recoveries are being handled in line with the Medical Schemes Act, CMS regulations and scheme rules, with further details to be shared during January.