Discovery Health wants money that was erroneously paid to members

Janu-worry just got worse for a number of Discovery Health members who are being asked to pay back money because of a system error.

CapeTalk's John Maytham asked Discovery Health CEO Dr Ron Whelan how much money in total was involved and whether it would not be in the company's best interest to simply own the error and not ask for the cash back.

Whelan did not answer those questions.

Instead, he said this is a deeply painful error for us.

"We apologise sincerely to all members impacted by this error. We recognise the frustration as well as the anger particularly at this time of the year."

"The error affects a very small proportion of the membership base, about 0.6 percent of members. And only impacts members on the Executive, Comprehensive and Priority plans... So it's a relatively contained error."

Maytham said Mark Hyman of MediCheck, a company that helps people with medical aid claims, has told him that the claw back is both against the Medical Schemes Act and against Discovery' own rules. However, Whelan insisted that they are acting justly.

"What the system has done is that it's effectively funded the above threshold benefits for these particular members at higher rates than the benefits available to them. Effectively these particular members impacted by the system error have received funding and benefits that they weren't entitled to in 2025. We acknowledge that this is a system error, nevertheless these members received benefits they weren't entitled to."

"The funds available in the medical scheme are the funds for all members in the medical scheme and right now there are 2.7-million beneficiaries across the Discovery Health Medical Scheme. And this risk pool or the funding pool is available to all members so to the extent that certain members receive disproportionate benefits through whatever mechanism that disadvantages the balance of the medical scheme... So this is a question of ensuring we maintain the integrity of the scheme rules. That we maintain consistency and fairness across all members of the medical scheme and that's really what we're seeking to achieve on this. It's akin to someone inadvertently paying money into your bank account. "