Which scheme shapes fit your headcount
How many people you employ decides which group private medical schemes an insurer will offer you, and what underwriting comes with each one. This page sets out the shapes available at each headcount, with the source for every threshold.
Why cover for one or two employees looks different
A scheme covering one or two people sits in a different place to a scheme covering a larger team. Insurers spread risk across everyone in a group, and a group of one or two gives them very little to spread, so the terms on offer can look more like individual cover than group cover in places.
AXA Health states that a group of 1 or 2 may face other exclusions and restrictions, beyond what applies once the group grows (AXA Health, read 4 October 2026). The insurer does not set out a single fixed list of what those restrictions are; each insurer's own scheme terms carry the detail.
If your business is at that size, this is a point worth raising directly with the insurer or adviser you speak to, before you assume the terms you've seen quoted for a larger group apply at yours.
How scheme shape changes with headcount
The shape of scheme available to you shifts at a few points as headcount rises. The table below sets out what changes at each point an insurer or broker has published a threshold for.
| Headcount | What changes | What to check |
|---|---|---|
| 1 or 2 employeesAXA Health, read 4 October 2026 | May carry other exclusions and restrictions that larger groups don't face | Ask the insurer which exclusions apply to a group this size before you commit |
| A small group, below the medical-history-disregarded threshold | Each employee's medical history is usually assessed on its own terms | Check whether terms change as the group grows closer to that threshold |
| Around 20 employeesDrewberry, read 4 October 2026 | Medical history disregarded underwriting usually becomes available, so pre-existing conditions don't need individual assessment | Confirm the exact figure with the insurer, since this is reported as a usual minimum. |
| 100 or more employeesAviva, read 4 October 2026 | Treated as a bespoke arrangement. | Expect terms to be negotiated for your group. |
These thresholds come from AXA Health, Drewberry and Aviva, as published and read on 4 October 2026. They show what each source states for a group of that size, not a guarantee that any insurer will offer the same terms to your company.
Where a healthcare trust fits alongside an insured scheme
An insured scheme is not the only way to put cover in place for your staff. A healthcare trust is a separate way of funding the same benefit, where the company meets claims from its own set-aside funds. It sits alongside the insured route at every headcount.
Why headcount changes the comparison
At small headcounts, an insured scheme usually makes the risk more predictable, because the insurer is pooling your staff with many other groups and pricing accordingly. A trust at this size means your company is exposed to the cost of whatever claims happen to land in a given year, with a small number of people to spread that cost across.
As headcount grows, that exposure smooths out. A larger group's claims tend to average out year on year, which is part of why a trust becomes a more realistic option for bigger employers and is rarely considered at all for very small ones.
The tax difference between the two
The choice also changes what the cover costs in tax, because Insurance Premium Tax applies to an insured premium but not to a healthcare trust arrangement. That difference in tax treatment runs alongside the difference in how the risk itself is held, and it is worth understanding both before weighing up which shape suits your company.
The insured scheme or healthcare trust explainer sets out that tax difference and the trust mechanism in full. The scheme shapes tool can show you where the insured options sit at your headcount; a trust is a decision to take up with an adviser or administrator who can set one up, rather than something the tool itself arranges.
What to check before you speak to an insurer
Knowing which scheme shapes exist at your headcount is the starting point. An insurer still has to confirm what it will actually offer your group, and a few questions are worth putting to them, or to a regulated adviser, before you sign anything.
What underwriting basis is on the table
Ask whether the group qualifies for medical history disregarded underwriting or whether moratorium underwriting is the only option at that size. The two carry different consequences for staff with pre-existing conditions, and the answer depends on headcount thresholds each insurer sets and publishes.
What happens to cover already excluded
If any employee has moved from an individual policy or a previous employer's scheme, ask whether continued personal medical exclusions carry across. An insurer may keep an existing exclusion in place.
What the group's size locks in or rules out
Confirm whether the shape you have been offered is fixed for the group's current size or whether it changes as headcount moves up or down. A scheme bought at one size can look different a year later if the group grows or shrinks across a published threshold.
Whether a healthcare trust is worth comparing
At some headcounts a healthcare trust is a genuine alternative to an insured scheme. It is worth asking an adviser to set out what a trust would mean for your group specifically.
None of this is a substitute for a conversation with an insurer or a regulated financial adviser about your own group. The scheme shapes a reader sees before that conversation can be a useful starting point, but the tool behind it can still give an answer that does not match what an insurer is prepared to offer your particular group. The underwriting differences and the trust versus insured scheme question are both worth reading before that call, so the questions you ask are the right ones.