Health Care Accountability Ordinance

The Health Care Accountability Ordinance (HCAO) applies to most City contractors and tenants (including those at the San Francisco International Airport and the Port of San Francisco). 

The HCAO requires employers to:

• Offer health plan benefits to their covered employees,
• Make payments to the City for use by the Department of Public Health, or
• Under limited circumstances, make payments directly to their covered employees

Fee rate

Effective July 1, 2023, covered employers who make payments to San Francisco General Hospital to satisfy the requirements of the HCAO must pay:

• $6.35 per hour, capped at $254.00 per work week

This rate is adjusted for inflation annually on July 1.

Healthy Airport Ordinance Amendment

The Healthy Airport Ordinance is an amendment to the HCAO for SFO Quality Standards Program Employees.

Mayoral Directives

Read the Mayoral Directive outlining health plan requirements for certain COVID-related essential services contracts.

HCAO poster (PDFs) - Must be displayed at each workplace

• English   Spanish   Chinese   Filipino

HCAO Employee Know Your Rights form - Employers must maintain copies signed by employees.

• English   Spanish   Chinese   Filipino

HCAO Voluntary Waiver form

•  English   Spanish   Chinese   Filipino

HCAO Payment form

•  HCAO Payment Form FY23-24

The San Francisco Board of Supervisors passed the Health Care Accountability Ordinance in 2001.

• Health Care Accountability Ordinance, SF Admin Code, Chapter 12Q
• Regulations Implementing the HCAO (PDF)

HCAO Minimum Standards and Guidance

• HCAO Minimum Standards and Guidance (Effective January 2023)
• HCAO Minimum Standards (Effective January 1, 2024)
• HCAO FAQ Common Clarifications, 2023-2024
  
  For questions regarding health plan requirements, contact Max Gara at the Department of Public Health at maxwell.gara@sfdph.org or 415-554-2621.
   
• Previous HCAO Minimum Standards for Health Plan Benefits

HCAO fee rates

•  HCAO Fee Option Rates Over Time (since 2001)

Complete MCO/HCAO Resource packets to download

•  MCO-HCAO Packet for City Contractors
•  MCO-HCAO Packet for SFO Contractors
•  MCO-HCAO Packet for SFO Leases and Concessions

For City Departments

• HCAO Contractor Compliance Declaration (HCO Declaration Word) (HCO Declaration PDF)
• List of Exemptions for the HCAO (PDF)

The following forms may be found on the City's Intranet:

• MCO Form P-360 Exemption & Waiver
• HCAO Form P-365 Exemption & Waiver

Video resources

• Videos about San Francisco labor laws

Hearing Decisions

• Hearing Officer Decisions

If you have any questions about your rights or responsibilities, contact us: 415-554-7903 or email hcao@sfgov.org.

You can file a complaint if you believe your rights have been violated.