An error on Discovery’s systems affected the way that certain prescription and over-the-counter medicines were processed in 2025.
2026 has got off to a financially challenging start for millions of Discovery Medical Aid members, who have had to fork out thousands of rands for an error in processing medicine claims for the entire 2025 year.
It is understood that an error on Discovery’s systems affected the way that certain prescription and over-the-counter medicines were processed in 2025.
“Because of this error, certain of your claims were counted toward and paid from the Above Threshold Benefit (ATB) at a higher rate than what the benefits allow,” Discovery Health COO Karen Sanderson informed affected clients in a letter seen by The Citizen.
“You reached your ATB earlier than expected because, instead of your medicine claims being accumulated and paid at the usual percentages of the Discovery Health Rate (DHR) – such as 0% for over-the-counter medicines, 50% for high-cost non-preferred medicines, and 75% for certain non-generic medicines – we processed and accumulated these claims at 100% of the DHR.”
ALSO READ: Discovery has a massive medical scheme problem
Claims
Discovery reprocessed the affected claims, with some requiring 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,” Discovery said in the letter to affected clients.
“You therefore received more cover from the scheme than what you qualified for. We need to correct this error to ensure that the benefits you received between January and December 2025 are in line with the scheme,” Sanderson said.
Discovery members angry
Discovery members took to social media to vent their frustrations about repaying the money, with many already carrying the burden of paying for school uniforms and stationery for their children ahead of the 2026 school academic year.
“Not only have I received this as well, but if you go to a doctor and pay the doctor directly, then claim back, they will deduct the amount they are supposed to pay you against that debt. No communication, no agreements entered, nothing. They just take it,” Gary Bernstein claimed on the Facebook page. “How I was messed around by Discovery Health Medical Aid.”
Mina Sean du Plessis on the same Facebook page wrote: “Oohhh Discovery just knows how to get your year started in a great way…. The time has come for me to take Discovery to CMS. How is the process working with CMS against Discovery? Is CMS really helpful? How many of you got an email stating they made an error and you owe them money now?”
ALSO READ: Discovery Group records profit, thanks to Discovery Bank
Payment plans
Discovery said affected customers will receive a statement detailing how much they owe.
“We’ll contact you to arrange a payment plan that works for your circumstances, as you will need to repay this amount back to the scheme.
“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. We’ll work with you to agree on a repayment arrangement which suits your circumstances. Our team is ready to answer any questions along the way,” Sanderson said.
The Citizen has contacted Discovery for comment. Any responses will be included once received.
ALSO READ: Top-end Discovery medical aid plans to increase by 10%