Understand Health Care Accountability Ordinance

Most City contractors and tenants (including at the Airport and the Port) must offer health plan benefits to their covered employees, make payment to the Department of Public Health, or, under limited circumstances, make payments directly to their covered employees.

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, 2022, covered employers who make payments to San Francisco General Hospital to satisfy the requirements of the HCAO must pay $6.10 per hour, capped at $244.00 per work week. This rate is adjusted for inflation annually on July 1.

Poster and Forms

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

HCAO Employee Know Your Rights 

HCAO Voluntary Waiver Form

HCAO Payment Form

HCAO Subcontractor Information Form 

HCAO Amendment & Mayoral Directive

Legal Authority

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

Resources

HCAO Minimum Standards and Guidance

HCAO Fee Rates

Complete MCO/HCAO resource packets to download

For City Departments

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

  • MCO Form P-360 Exemption & Waiver

  • HCAO Form P-365 Exemption & Waiver

Videos about San Francisco labor laws

Contact us

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.

Last updated December 19, 2022