Health Care Accountability Ordinance

New! HCAO Minimum Standards, effective January 1, 2023

From August 11, 2022 to December 31, 2022, employers have the option to comply with these standards or the current 2022 standards. 
PDF icon HCAO Minimum Standards, Effective Jan 1, 2023

HCAO Minimum Standards Webinar Recording - Effective January 1, 2023
PDF icon video slides

For questions regarding health plan requirements, contact Max Gara at the Department of Public Health at or (415) 554-2621.

New! HCAO Fee Rate
       Effective July 1, 2022, the HCAO fee rate is $6.10 per hour, capped at $244.00 per week.

HCAO Amendment & Mayoral Directive

 Email list Sign up to receive periodic email updates about the Health Care Accountability Ordinance (HCAO) and the Minimum Compensation Ordinance (MCO).


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.

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.

Forms and Documents - For Employers

HCAO Minimum Standards and Guidance
HCAO Poster
HCAO Employee Know Your Rights 
HCAO Voluntary Waiver Form
HCAO Payment Form
HCAO Fee Rates
HCAO Subcontractor Information Form 
Complete MCO/HCAO resource packets to download
HCAO Webinars
Hearing Officer Decisions

Filing a Complaint - For Employees

Employee Complaint Form
PDF icon English  Spanish  Chinese  Russian  Vietnamese  Filipino

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