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, to make payments to the City for use by the Department of Public Health, or, under limited circumstances, to make payments directly to their covered employees.

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.

HCAO Poster (PDFs) - Must be displayed at each workplace
 English Spanish Chinese Filipino

HCAO Employee Know Your Rights 

• 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

HCAO Subcontractor Information Form 

•  HCAO Subcontractor Information Form - This form must be filled out by the Prime Contractor, who is responsible for the Subcontractor's compliance.

• Healthy Airport Ordinance (HCAO Amendment for SFO Quality Standards Program Employees)
   
• Health Plan Requirements for Specified COVID-Related Essential Services Contracts

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  Word  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

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.