Health Care Accountability Ordinance

New! HCAO Amendment & Mayoral Directive

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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, 2021, covered employers who make payments to San Francisco General Hospital to satisfy the requirements of the HCAO must pay $5.85 per hour, capped at $234.00 per work week. This rate is adjusted for inflation annually on July 1.

If you have questions about the San Francisco Health Care Accountability Ordinance or wish to report a violation of the law, call 415-554-7903 or email

HCAO Poster

Statutory Authority

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

For Employers

HCAO Webinars

For Employees

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