Under the Health Care Security Ordinance (HCSO), all covered employers must meet the following obligations:
- Satisfy the Employer Spending Requirement by making required health care expenditures on a quarterly basis on behalf of all covered employees.
- Check the employer expenditure rate table for current rates.
- Covered employees are those who have been employed for more than 90 days and who regularly work at least 8 hours per week in San Francisco.
- Maintain records to show that you are in compliance with HCSO.
- Post the 2023 HCSO Poster (effective January 1, 2023) in all workplaces with covered employees.
- Submit an HCSO Annual Reporting Form to the OLSE by April 30th of each year.
Employer expenditure rates
Find current and recent expenditure rates in the table provided. We also have an accessible version of the expenditure rate table.
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.
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
- Contributions to programs that reimburse employees for out-of-pocket health care costs
Administrative Code and Rules
- San Francisco Administrative Code Chapter 14: Health Care Security Ordinance
- Health Care Security Ordinance Rules
FAQ / Administrative Guidance
Get the full HCSO Administrative Guidance or browse by topic:
- A: Overview
- B: Covered Employers
- C: Covered Employees
- D: Calculating Required Health Care Expenditures
- E: Making Required Health Care Expenditures
- F: Revocable and Irrevocable Health Care Expenditures
- G: Contributing to the City Option
- H: Employer Notice-Posting Requirement
- I: Employer Recordkeeping Requirements
- J: Employer Reporting Requirements
- K: Health Surcharges
- L: Retaliation Prohibited
- M: Filing a Complaint
- N: Penalties
- O: HCSO and the Affordable Care Act
Advisory: The HCSO Administrative Guidance has not been revised to reflect all of the changes that took effect on January 1, 2017. Certain provisions of this Guidance, therefore, may not be consistent with the Health Care Security Ordinance ("HCSO"), Administrative Code Chapter 14. In particular, no provision of the Guidance should be interpreted to mean that anything other than fully irrevocable Health Care Expenditures can be counted toward the employer spending requirement, as of first quarter of 2017. In any instance where the Administrative Guidance, or the Regulations, conflict with the Ordinance, the Ordinance itself governs and should be followed instead.
HCSO poster - Must be displayed at each workplace with covered employees.
- 2023 HCSO Poster (effective January 1, 2023)
HCSO Employee Voluntary Waiver form (PDFs)
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
If you have any questions about your rights or responsibilities, contact us: 415-554-7892 or email email@example.com.