Health Care Security Ordinance

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Updated August 25, 2022 - 2023 Health Care Expenditure Rates

As of January 1, 2023, the required Health Care Expenditure Rates for large businesses (100+ employees) will be $3.40 per hour. The rate for medium-sized businesses (20-99 employees) will be $2.27.

Exemption Threshold: As of January 1, 2023, managerial, supervisory, and confidential employees who earn more than $114,141 per year (or $54.88 per hour) are exempt.

Updated July 19, 2021 - San Francisco Amendment on Telework during Health Order Restrictions

The San Francisco Board of Supervisors passed an amendment to the Health Care Security Ordinance (HCSO) on June 22, 2021. The legislation provides HCSO coverage to employees working remotely outside of San Francisco while public health orders recommend that employees work remotely.

Note that the City’s June 11th public health order removed the recommendation that employers “allow office employees to continue to work remotely as much as possible.” Unless or until new City health order restrictions are issued, employees working remotely outside of San Francisco are not covered by the HCSO employer spending requirements. Find information on who is covered by the HCSO here.



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 a quarterly basis 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 Workers 2022 Expenditure Rate 2023 Expenditure Rate


All employers w/ 100+ workers $3.30 per hour payable  $3.40 per hour payable


Businesses w/ 20-99 workers
Nonprofits w/ 50-99 workers
$2.20 per hour payable  $2.27 per hour payable


Businesses w/ 0-19 workers
Nonprofits w/ 0-49 workers
  Exempt   Exempt
  • 2022 Exemption Threshold: managerial, supervisory, and confidential employees who earn more than $109,643 annually (or $52.71 per hour) are exempt. As of January 1, 2023, the new threshold will be $114,141 per year (or $54.88 per hour).  More information and rates from prior years are available here.

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

3. Post the PDF icon 2022 HCSO poster in all workplaces with covered employees.

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

If you have questions about the San Francisco Health Care Security Ordinance or wish to report a violation of the law, call 415-554-7892 or email

Statutory Authority

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


Download the full PDF icon HCSO Administrative Guidance

Filing a ComplaintHCSO Complaint Form English

To report a violation of the Health Care Security Ordinance, please complete the HCSO Complaint Form and submit it to the Office of Labor Standards Enforcement, or call (415) 554-7892.

OLSE Health Care Security Ordinance Complaint Form (PDFs)
PDF icon English  PDF icon Spanish  PDF icon Chinese

You can email it to, fax it to (415) 554-6291, or bring it to the OLSE office at:

City Hall, Room 430 
Dr. Carlton B. Goodlett Place
San Francisco, CA 94102


Forms & Documents HCSO 2022 Poster

Annual Reporting

Employers covered by the Health Care Security Ordinance are required to submit the Employer Annual Reporting Form by April 30 each year or face penalties of up to $500 per quarter.

Consistent with the Mayor's February 25th, 2020 Emergency Proclamation on COVID-19, the City of San Francisco waived the employer requirement to submit the 2019 and 2020 Annual Reporting Forms for the Health Care Security and Fair Chance Ordinances. Note that employers are required to comply with all other aspects of the Health Care Security and Fair Chance Ordinances. See the legislative record for details.

PDF icon HCSO Annual Reporting Summary for 2014-2017

2021 Annual Reporting Form (ARF): Due May 2, 2022 

​​​2021 Employer Annual Reporting Form

Webinar - HCSO Annual Reporting Form

PDF icon 2021 ARF Introductory Questions

PDF icon 2021 ARF PDF Preview

PDF icon 2021 ARF Written Instructions

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. Employees who receive these contributions will be eligible for:

  • a SF Medical Reimbursement Account, a health care account with funds that can be used for eligible health care expenses incurred by the employee, the employee's spouse or registered domestic partner, and the employee's dependents;

Upon contributing to the SF City Option, employers must provide their employees with a one-time Health Care Payment Confirmation notice. Employers are also encouraged to display the SF City Option Poster. Download these materials here.

To learn more about contributing to the SF City Option, visit or contact SF City Option 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.

Contact Us 

  • Please email or call (415) 554-7892 with any questions regarding your rights and responsibilities under the San Francisco Health Care Security Ordinance.
  • Sign up for email updates! Join the OLSE email list to receive periodic updates about San Francisco labor laws.