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Overview
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:
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Employer Size
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Number of Workers |
2019 Expenditure Rate |
2020 Expenditure Rate |
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Large
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All employers w/ 100+ workers |
$2.93 per hour payable |
$3.08 per hour payable |
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Medium
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Businesses w/ 20-99 workers
Nonprofits w/ 50-99 workers |
$1.95 per hour payable |
$2.05 per hour payable |
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Small
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Businesses w/ 0-19 workers
Nonprofits w/ 0-49 workers |
Exempt |
Exempt |
- 2019 Exemption Threshold: managerial, supervisory, and confidential employees who earn more than $100,796 (or $48.46 per hour) are exempt. 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  2019 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 hcso@sfgov.org.
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Statutory Authority
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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.
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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
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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
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Download the HCSO Administrative Guidance
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Filing a Complaint
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)
English Spanish Chinese
You can email it to hcso@sfgov.org, 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
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Forms & Documents 
- 2019 HCSO Poster - must be posted at all workplaces or job sites
- HCSO Employee Voluntary Waiver Form (PDFs)
English Chinese Spanish Filipino
- HCSO Training: OLSE held an employer webinar on the requirements of the HCSO on December 7, 2017.
- Self-Funded Plan Resources: OLSE held a webinar on calculating Health Care Expenditures for self-funded plans and making "top-off" payments on February 8, 2019.
- Hearing Officer Decisions
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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. The 2018 Employer Annual Reporting form is no longer available. The 2019 form will be available in April 2020.
HCSO Annual Reporting Summary for 2014-2017
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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:
(1) enrollment in 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; or
(2) enrollment in a SF Covered Medical Reimbursement Account, a health care spending account for employees enrolled in a health insurance plan through Covered California; or
(3) free or discounted enrollment into Healthy San Francisco, a health care access program designed to make health care services available and affordable to uninsured San Francisco residents.
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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.
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Contact Us
- Please email hcso@sfgov.org 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.
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