Health Care Accountability Ordinance

New! On November 10, 2020, the Board of Supervisors adopted the Healthy Airport Ordinance, which amends the Health Care Accountability Ordinance for specified workers at the San Francisco International Airport. Covered employers must comply with the ordinance's requirements on its operative date, March 20, 2021.

NEW: HCAO Minimum Standards & Guidance, Effective 1/1/2021-12/31/2022

NEW: Webinar: HCAO Minimum Standards Webinar, Effective 1/1/2021 

HCAO Minimum Standards Webinar - PDF icon Slides and PDF icon Handout. Effective January 1, 2021, there are NEW HCAO Minimum Standards.  Join the Office of Labor Standards Enforcement (OLSE) and the Department of Public Health (DPH) at this webinar to receive a detailed and comprehensive presentation of the NEW HCAO Minimum Standards.  The information will be technical it is intended for insurance brokers/representatives, benefits representatives, as well as human resources directors/representatives. 


NEW: Webinars now available here

Health Plan Requirements for Specified COVID-19 Essential Services Contracts Effective May 13, 2020 - With limited exceptions, City contractors that enter into a COVID-19 essential services contract for food service, delivery of food, janitorial services, or cleaning services must offer their covered employees and covered employees’ dependents health plan benefits that meet the PDF icon minimum standards prepared by the Health Director.  Covered employees are employees that work for 2 hours or more per week on the essential services contract within San Francisco.

These requirements apply to COVID-19 essential services contracts first advertised, selected, or initiated after May 13, 2020.

To read the full Mayoral Directive, click PDF icon here.  For more information, call (415) 554-7903 or email


  • New!  Effective July 1, 2020, the HCAO fee rate increases to $5.60 per hour, capped at $224.00 per week.
  •   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, 2020, covered employers who make payments to San Francisco General Hospital to satisfy the requirements of the HCAO must pay $5.60 per hour, capped at $224.00 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