Health Care Security Ordinance

Most San Francisco employers must spend a minimum amount on health care for employees who work 8 or more hours per week.

Updates

Self-funded health insurance plans due February 29, 2024

Employers who use self-funded health insurance plans to comply with the HCSO must calculate the value of their 2023 health plan(s) and make any required top-off payments by February 29, 2024.

     Webinar recording and resources:

Overview

Under the Health Care Security Ordinance (HCSO), all covered employers must meet the following obligations:

  • Satisfy the Employer Spending Requirement by making required health care expenditures on a quarterly basis on behalf of all covered employees.
    • Check the employer expenditure rate table for current rates.
    • Covered employees are those who have been employed for more than 90 days and who regularly work at least 8 hours per week in San Francisco.
  • Maintain records to show that you are in compliance with HCSO.
  • Post the 2024 HCSO Poster (effective January 1, 2024) in all workplaces with covered employees.
  • Submit an HCSO Annual Reporting Form to the OLSE by April 30th of each year. The form will not be available until April 1, 2024.

Employer expenditure rates

Find current and recent expenditure rates in the table provided. We also have an accessible version of the expenditure rate table.

Health Care Security Ordinance (HCSO) expenditure rates

Exemption Threshold: As of January 1, 2024, managerial, supervisory, and confidential employees who earn more than $121,372 per year (or $58.35 per hour) are exempt.

Compliance options

Employers can choose how to spend the money on health care for their employees. Some of the common expenses 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

Legal authority

Administrative Code and Rules

FAQ / Administrative Guidance

Get the full HCSO Administrative Guidance or browse by topic:

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

Resources

HCSO poster - Must be displayed at each workplace with covered employees.

HCSO Employee Voluntary Waiver form (PDFs)

Self-Funded Health Plans webinar and resources

Video resources

Hearing Decisions

Contact us

If you have any questions about your rights or responsibilities, contact us: 415-554-7892 or email hcso@sfgov.org.

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

Last updated February 16, 2024