Health Care Security Ordinance
Administrative Guidance
 

A. HCSO 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 SF 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
 

1. Q: What is the Health Care Security Ordinance? 
2. Q: What does the HCSO require employers to do?
3. Q: What types of expenditures can employers make to comply with the HCSO employer spending requirement? 

 1. Q: What is the Health Care Security Ordinance?

A: The Health Care Security Ordinance (HCSO) is a San Francisco law that:

• established several employer health care-related obligations enforced by the Office of Labor Standards Enforcement (OLSE) and
• created a Health Access Program, including Healthy San Francisco and Medical Reimbursement Accounts, administered by the San Francisco Department of Public Health.

2. Q: What does the HCSO require employers to do? 

A: Under the HCSO, all Covered Employers must meet the following obligations:

• Satisfy the Employer Spending Requirement (ESR) by calculating and making required health care expenditures on behalf of all Covered Employees.
• Maintain records sufficient to establish compliance with the ESR.
• Post an HCSO Notice in all workplaces with covered employees.
• Submit an HCSO Annual Reporting Form to the OLSE by April 30th of each year.

3.  Q: What types of expenditures can employers make to comply with the HCSO Employer Spending Requirement?

A: Employers choose how to make the required Health Care Expenditures for their Covered Employees. Common Health Care Expenditures include:

• Payments for health, dental, and/or vision insurance;
• Payments to the SF City Option;
• Contributions to programs that reimburse employees for out-of-pocket health care costs, subject to the limitations described in Administrative Guidance Section F.

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