Health Care Security Ordinance

Overview 

Under the Health Care Security Ordinance (HCSO), all covered employers must meet the following obligations:

1.  Satisfy the Employer Spending Requirement by making required health care expenditures on a quarterly basis on behalf of all covered employees (those who have been employed for more than 90 days and who regularly work at least 8 hours per week in San Francisco) at the following rates.

• 2024 Expenditure Rate:
  If you have 100 or more workers: $3.51 per hour 
  If you have 20 to 99 workers worldwide (or nonprofits with 50-99 workers): $2.34 per hour
  If you have 0 to 19 workers (or 0 to 49 for nonprofits), you do not need to meet this requirement
• 2023 Expenditure Rate:
  If you have 100 or more workers: $3.40 per hour 
  If you have 20 to 99 workers worldwide (or nonprofits with 50-99 workers): $2.27 per hour
  If you have 0 to 19 workers (or 0 to 49 for nonprofits), you do not need to meet this requirement
• Exemption Threshold: As of January 1, 2024, managerial, supervisory, and confidential employees who earn more than $121,372 per year (or $58.35 per hour) are exempt.

2.  Maintain records to show that you are in compliance with HCSO.

3.  Post the poster in all workplaces with covered employees.

• 2023 HCSO Poster - effective January 1, 2023 

4.  Submit an HCSO Annual Reporting Form to the OLSE by April 30th of each year.

Employers can choose how to spend the money on health care for their employees. Some of the common expenses include:

• Payments for health, dental, and/or vision insurance
• Payments to the SF City Option 
  To learn more about contributing to the SF City Option, attend a training, visit www.sfcityoption.org, or contact SF City Option at employerservices@sfcityoption.org or (415) 615-4492.​
• Contributions to programs that reimburse employees for out-of-pocket health care costs

• HCSO FAQ - Administrative Guidance
• San Francisco Administrative Code Chapter 14: Health Care Security Ordinance
• Health Care Security Ordinance Rules

• 2023 HCSO Poster - effective January 1, 2023

Must be posted in all workplaces with covered employees.

• HCSO Employee Voluntary Waiver Form (PDFs)
  • English  Chinese  Spanish  Filipino
• HCSO Video Resources
• OLSE-City Option Webinar recording, September 6, 2023
   
• Self-Funded Health Plans Webinar and Resources
  Recording of Self-Funded Health Plans Webinar, January 31, 2023
  Slides from the Self-Funded Health Plans Webinar, January 31, 2023
  HCSO Self Funded of Instructions for 2022
  Sample letter to employees regarding top off
• Hearing Officer Decisions

If you have any questions about your rights or responsibilities, contact us: 415-554-7892 or email hcso@sfgov.org.

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