Overview
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, 2024, covered employers who make payments to San Francisco General Hospital to satisfy the requirements of the HCAO must pay:
- $6.75 per hour, capped at $270.00 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.
Poster and forms
HCAO poster (PDFs) - Must be displayed at each workplace
HCAO Employee Know Your Rights form - Employers must maintain copies signed by employees.
HCAO Voluntary Waiver form
HCAO Payment form
Legal authority
The San Francisco Board of Supervisors passed the Health Care Accountability Ordinance in 2001.
Resources
HCAO Minimum Standards and Guidance
- HCAO Minimum Standards (Effective January 1, 2025)
- HCAO FAQ Common Clarifications, 2024-2025
For questions regarding health plan requirements, contact Max Gara at the Department of Public Health at maxwell.gara@sfdph.org or 628-271-7517.
- 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)
- MCO and HCAO Declaration Video
- 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
- HCAO Minimum Standards Webinar Effective January 1, 2025
HCAO Minimum Standards Webinar Slides - Videos about San Francisco labor laws
Hearing Decisions
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.