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The damage is applied before the healing effect. Thus players who attempt to self-heal, expecting a net gain of health, may end up dead if their health is already too low.
Skills which include a secondary, conditional heal such as Words of Comfort will trigger Scourge Healing twice if the condition is met. This can be especially lethal when using Heal Party or Light of Deliverance, if there are many allies hexed with Scourge Healing, as it will trigger for every ally affected by the hex. This skill is therefore often used in hex builds containing plenty of degen to discourage the use of party-wide heals. It is also extremely dangerous to a Necromancer using Blood of the Master while several of their minions are hexed.
Shouts that heal when it ends will trigger Scourge Healing as well.
Non-Triggers
This does not include healing received due to the Divine Favor attribute, nor a Divine Boon bonus.
It does not trigger on secondary healing effects from Enchantments such as with Vigorous Spirit and Healing Hands.
If an enemy is hexed with Scourge Healing, and you cast Heal Area right next to that enemy, thus healing them, you will not suffer damage from Scourge Healing. Healing enemies through Illusion of Pain won't damage the caster either.
It also will not trigger on certain monster skills, such as Nibble.