Health Care Security Ordinance (HCSO)


 HCSO News



  • New!  As of January 1, 2017 the health care expenditure rate will be $2.64 per hour for large businesses (100 or more employees total) and $1.76 per hour for medium-sized businesses (20-99 employees total). For information on how the rate is calculated, see the definition of "Health Care Expenditure" in San Francisco.


  • New!  PDF icon2017 HCSO Notice - Employers must post this Notice at workplaces as of January 1, 2017.


  • The San Francisco Board of Supervisors passed an amendment to the HCSO on June 17, 2014. The amendment phases in (over 3 years) a requirement that all heath care expenditures be made irrevocably. See text of the HCSO amendment.




  • 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 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:

 Employer Size

Number of Employees  2016 Expenditure Rate  2017 Expenditure Rate
 Large All employers w/100+ employees  $2.53 per hour payable  $2.64 per hour payable
 Medium Businesses w/20-99 employees
Nonprofits w/50-99 employees
 $1.68 per hour payable  $1.76 per hour payable

Businesses w/0-19 employees
Nonprofits w/0-49 employees

 Exempt  Exempt

2. Maintain records sufficient to establish compliance with the employer spending requirement.

3. Post an HCSO Notice in all workplaces with covered employees.

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

For details about these and other requirements, see our Administrative Guidance, review our other resources, or contact the OLSE at or (415) 554-7892 .

Employees who believe their rights have been violated may submit an HCSO Complaint Form (PDF).


 Administrative Guidance


A. Overview
B. Covered Employers
C. Covered Employees
D. Calculating Required Health Care Expenditures
E. Making Required Health Care Expenditures
F. Revocable & 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
P. Expenditures and Enforcement Guidance for 2014


Download PDF iconHCSO Administrative Guidance Sections A-O

Download PDF iconHCSO Administrative Guidance Section P on 2014 Expenditures and Enforcement



 Email Updates

  • Sign up for email updates! Join the OLSE email list for employers with 20 or more total employees (including those outside of San Francisco) to receive periodic updates about applicable San Francisco labor laws.

 General HCSO Resources




 Annual Reporting



The 2015 Employer Annual Reporting Form is now available. Covered employers must submit the 2015 Employer Annual Reporting Form by April 30, 2016 or be subject to penalties of $500 per quarter. 


  • Please review the 2015 Employer Annual Reporting Form Instructions.  
  • Download a PDF iconPDF Preview of the Employer Annual Reporting Form.Please note that once you begin the online form, you cannot save it to return to it later. 
  • Access the online 2015 Employer Annual Reporting Form.
  • Recording of an April 19, 2016 webinar on how to complete the 2015 Employer Annual Reporting Form. Please note that the audio is silent for the first 15 secords of the recording. 
  • PDF iconSlide deck from the April 19 webinar on how to complete the 2015 Employer Annual Reporting Form.
  • If you require a paper copy of the 2015 Employer Annual Reporting Form, please call us at (415) 554-7892.


The Office of Labor Standards Enforcement reports on the Annual Reporting Forms that employers submit each year.


 San Francisco City Option (Healthy San Francisco and Medical Reimbursement Accounts)

  • One way that employers may comply with the HCSO’s spending requirement is by making contributions to the City Option on behalf of their covered employees. Depending upon eligibility, employees who receive these contributions will receive:
    • free or discounted enrollment in the Healthy San Francisco program, or
    • a Medical Reimbursement Account to pay for out-of-pocket medical expenses.
  • Upon contributing to the City Option, employers must provide their employees with a one-time Employee Health Care Payment Confirmation (PDF) (English) (Chinese) (Spanish) (Filipino/Tagalog).
  • To learn more about contributing to the City Option, visit or contact City Option Program Management at or (415) 615-4492 



 Health Care Surcharges

  • Businesses are neither required to, nor prohibited from, imposing surcharges on their customers to offset the cost of complying with the Health Care Security Ordinance. However, employers that elect to impose such surcharges must comply with specific requirements.
  • On May 1, 2009, the State Board of Equalization issued a Special Notice (PDF) regarding the taxability of such surcharges. To reach the State Board of Equalization, please call 800.400.7115.



 Hearing Officer Decisions and Upcoming Administrative Hearings and




 Contact Us

  • Please email or call 554-7892 with any questions regarding your rights and responsibilities under the San Francisco Health Care Security Ordinance.