Health Care Accountability Ordinance

Most City contractors and tenants (including at the Airport and the Port) must offer health plan benefits to their covered employees, make payment to the Department of Public Health, or, under limited circumstances, make payments directly to their covered employees.


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,
  • Make payments to the City for use by the Department of Public Health, or
  • Under limited circumstances, make payments directly to their covered employees

Fee rate

Effective July 1, 2024, covered employers who make payments to San Francisco General Hospital to satisfy the requirements of the HCAO must pay:

  • $6.75 per hour, capped at $270.00 per work week

This rate is adjusted for inflation annually on July 1.

Healthy Airport Ordinance Amendment

The Healthy Airport Ordinance is an amendment to the HCAO for SFO Quality Standards Program Employees.

Mayoral Directives

Read the Mayoral Directive outlining health plan requirements for certain COVID-related essential services contracts.

Poster and forms

HCAO poster (PDFs) - Must be displayed at each workplace

HCAO Employee Know Your Rights form - Employers must maintain copies signed by employees.

HCAO Voluntary Waiver form

HCAO Payment form

Legal authority

The San Francisco Board of Supervisors passed the Health Care Accountability Ordinance in 2001.


HCAO Minimum Standards and Guidance

HCAO fee rates

Complete MCO/HCAO Resource packets to download

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

Video resources

Hearing Decisions

Contact us

If you have any questions about your rights or responsibilities, contact us: 415-554-7903 or email

You can file a complaint if you believe your rights have been violated.

Last updated June 5, 2024