Health Care Security Ordinance (HCSO)


 HCSO News



  •  NEW 2018 RATES: As of January 1, 2018 the health care expenditure rate will be $2.83 per hour for large businesses (100 or more employees total) and $1.89 per hour for medium-sized businesses (20-99 employees total).


  • NEW POSTER: The Office of Labor Standards Enforcement's Official PDF icon2018 HCSO Poster must be posted at all workplaces or job sites as of January 1, 2018. 


  • NEW TRAINING: The Office of Labor Standards Enforcement held an employer webinar on the requirements of the HCSO on Decebmer 7, 2017. View the recording of the HCSO webinar. Note that there is a short delay in the recording before slides are visible. You can also the PDF iconHCSO webinar slide deck to review. 


  • NEW HCSO Employee Voluntary Waiver Form: the San Francisco Office of Labor Standards Enforcement published a new Employee Voluntary Waiver Form (PDF) on November 1, 2017. Employees may voluntarily choose to sign this waiver only if they have health benefits through another employer (such as a parent or spouse's employer). Be sure to review the HCSO Rule  3.8 in the New HCSO Rules for more information on the use of the Waiver. 


  • NEW HCSO RULES: After considering public input on proposed HCSO Rules, the San Francisco Office of Labor Standards Enforcement published new PDF iconHealth Care Security Ordinance Rules on October 10, 2017. The new Rules took effect on October 29, 2017.


  • As of January 1, 2017, employers may no longer make revocable Health Care Expenditures to comply with the spending requirement of the HCSO. See the HCSO Administrative Guidance on Revocable & Irrevocable Health Care Expenditures. The San Francisco Board of Supervisors phased out the use of Revocable Health Care Expenditures in the 2014 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  2017 Expenditure Rate  2018 Expenditure Rate
 Large All employers w/100+ employees  $2.64 per hour payable  $2.83 per hour payable
 Medium Businesses w/20-99 employees
Nonprofits w/50-99 employees
 $1.76 per hour payable  $1.89 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:



 Administrative Guidance


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.  Contact OLSE for more information.


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 icon HCSO 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 2017 Employer Annual Reporting form will be available by April 1, 2018 and will be due on April 30, 2018.


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



 San Francisco City Option

  • One way that employers may comply with the HCSO’s spending requirement is by making contributions to the SF City Option on behalf of their covered employees. Depending upon eligibility, employees who receive these contributions will receive:
    • enrollment in the SF MRA or SF Covered MRA programs to pay for out-of-pocket medical expenses
    • free or discounted enrollment in the Healthy San Francisco program; or
  • Upon contributing to the SF 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 SF City Option, visit or contact SF 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.