Run one group scheme with a hospital list that works in every region, then use categories (by grade or site) if cover needs differ — not separate per-site policies, which cost more and multiply admin. Expect £35–£110 per employee/month, with London-based staff at the top of the range; larger groups typically get medical history disregarded underwriting.
- ✓One scheme with employee categories beats separate per-site policies on price and admin.
- ✓The hospital list is the multi-site decision: it must deliver comparable access in every region, not just HQ's.
- ✓London postcodes push premiums to the top of the £35–£110 range — extended London lists cost more again.
The core decision: one scheme or several?
Multi-site employers sometimes inherit a patchwork — a policy per site, often with different insurers, bought as each location opened. Consolidating into one group scheme is almost always better: a single risk pool prices more keenly (group cover typically runs 10–30% cheaper per head than fragmented arrangements), one renewal replaces several, and staff who move between sites don't change policy or lose underwriting continuity.
Where sites genuinely need different treatment — a head office with an executive tier, warehouses with a core plan — the tool is employee categories within one scheme, not separate policies. Insurers routinely price categories by grade, site or role, each with its own cover level and hospital list, all on one invoice with per-member billing.
Hospital lists: the real multi-site problem
A hospital list that looks generous from head office can be thin where your other sites are. Every insurer's standard national list covers the big private groups — Spire, Circle, Nuffield Health, Practice Plus — but density varies by region, and the premium bands are driven largely by whether expensive central-London hospitals (HCA and similar) are included. The multi-site question is always: what can a member near each site actually reach?
| List strategy | How it works multi-site | Cost effect |
|---|---|---|
| Standard national list | Good coverage near most regional sites; excludes premium central-London hospitals | Baseline |
| Extended / London list | Adds HCA-type central-London hospitals — relevant mainly to London staff | Typically +15–25% on affected members |
| Local/restricted list | Trimmed network; fine in well-served cities, check gaps near smaller sites | Typically −10–20% |
| Mixed by category | London category on extended list, regional categories on standard | Pays for reach only where used |
Before renewal, sanity-check the list against a map of your sites: for each location, count the in-list private hospitals within a reasonable drive, and check the specialties that matter (orthopaedics and cardiology are the usual gaps in thin areas). Guided-referral options — where the insurer directs members to approved consultants — can keep costs down while smoothing regional variation. Our hospital lists guide covers the mechanics.
The London weighting question
Insurers price partly by postcode, and London (plus the South East) sits at the top: treatment costs more there, so London-registered members push toward the upper end of the £35–£110 per employee per month band while the same cover in the North or Midlands sits lower. A business with 60 staff in Manchester and 40 in London will see that blend in its per-head rate.
The design choice is whether London staff also get a London hospital list. Two defensible answers: give everyone the standard national list (London staff still have solid non-HCA options in outer London) and hold costs level; or create a London category with the extended list, accepting the 15–25% uplift on those members as part of the location package — common where the London site competes for talent against employers offering exactly that. What rarely makes sense is buying the extended London list for the whole national workforce: you'd pay a premium for hospitals most staff will never use.
One scheme across every site
Admin at scale: joiners, leavers, movers
With staff across sites, membership churn is constant, and the scheme is only as good as its data feed. The essentials:
- Single owner, single process. One HR or benefits owner submits all membership changes — per-site ad hoc emails to the insurer end in duplicate or orphaned members.
- Monthly movement reports. Most insurers accept a joiner/leaver/transfer schedule monthly; reconcile it against payroll headcount by site each quarter.
- Eligibility rules in writing. Define who's covered (waiting period, hours threshold, which categories) identically across sites so managers can't improvise local variations.
- Pro-rata housekeeping. Joiners and leavers generate part-year premiums and refunds that feed P11D values and the Class 1A total — the per-member statement is the audit trail.
- Underwriting at size. Larger groups — often from around 15–20 lives — typically get medical history disregarded (MHD) terms, which removes individual underwriting entirely and makes cross-site transfers and new-site rollouts frictionless.
The same infrastructure handles growth: opening site number six is a category decision and a data-feed update, not a new policy purchase.
Getting it quoted properly
Multi-site quotes are only as accurate as the census: insurers will want a member list with work location or home postcode, age, and category for each employee — not just a headcount. Provide the site split up front and ask each insurer to model two or three list strategies (standard everywhere; London category on extended; restricted list on regional sites) so you're comparing designs, not just brands.
At 50+ employees the market sharpens further and claims-experience pricing enters at the larger end — our 50-employee guide covers that stage. Whatever the size, the multi-site test for any proposal is the same: would an employee at your smallest, most remote site rate this benefit as highly as one at head office? If yes, the design is right. And if the list debate stalls internally, a one-year pilot at a single regional site settles it with claims data rather than opinions.
Frequently asked questions
Should a multi-site business have one health insurance scheme or one per site?
One scheme, almost always. A single group policy prices a bigger risk pool — typically 10–30% cheaper per head than fragmented arrangements — replaces several renewals with one, and keeps underwriting continuity when staff move between sites. Where sites need different cover, use categories within the scheme rather than separate policies.
How do hospital lists work for a business with offices in different regions?
The scheme's hospital list applies to each member, so it has to deliver comparable access near every site, not just head office. Standard national lists cover the main private groups (Spire, Nuffield Health, Circle) in most regions; the check is counting in-list hospitals within a reasonable drive of each location, especially for orthopaedics and cardiology.
Do London employees make a group health insurance scheme more expensive?
Yes — insurers price partly by postcode, and London treatment costs push those members toward the top of the £35–£110 per-employee monthly band. Adding an extended London hospital list (HCA-type hospitals) typically costs a further 15–25% on affected members, which is why many employers restrict it to a London category or skip it.
Can different sites have different levels of health insurance cover?
Yes, through employee categories within one scheme: insurers routinely price separate tiers by site, grade or role, each with its own cover level and hospital list, on one invoice. Category by grade usually works better long-term than category by site, because relocating staff then keep their tier without paperwork.
Is it worth putting the whole company on a London hospital list?
Rarely. The extended London list premium — typically 15–25% — buys access to central-London hospitals most regional staff will never use. The common designs are a standard national list for everyone, or an extended-list category for London-based staff only, funded as part of that site's location package.
How does a multi-site company handle health insurance for staff who relocate?
Treat site moves as a membership event: notify the insurer so the member's postcode, and category if cover differs by site, are updated. Within one group scheme the member keeps underwriting continuity. Untracked relocations distort pricing data and are a classic source of multi-site renewal surprises.
What does the insurer need to quote a multi-site health insurance scheme?
A member census, not just a headcount: age and work location or home postcode for each employee, plus the intended category structure. The site split materially changes pricing, so provide it up front and ask insurers to model alternative hospital-list strategies so you can compare designs on cost.
How do joiners and leavers get managed on a multi-site health scheme?
Through one central process: a single benefits owner submits monthly joiner, leaver and transfer schedules to the insurer, reconciled quarterly against payroll by site. Each change generates pro-rata premiums or refunds that feed P11D values and the Class 1A NIC total, so the per-member statement doubles as the audit trail.
Does a large multi-site scheme get medical history disregarded underwriting?
Typically yes from around 15–20 lives upward — MHD covers pre-existing conditions without individual underwriting, which suits multi-site employers especially: transfers between sites, acquisitions and new-site rollouts all onboard staff without medical declarations. Smaller multi-site schemes usually start on moratorium terms instead.
Does opening a new site mean a new health insurance policy?
No — with a single group scheme it's a data-feed update: add the new site's staff to an existing or new category, check the hospital list serves the new location, and the insurer adjusts billing pro-rata. That's a fraction of the cost and admin of buying a separate local policy.