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Health Care Security Ordinance (HCSO)


 HCSO News

  • New! The Office of Labor Standards Enforcement (OLSE) is holding an online webinar on January 6, 2015 to review compliance with the HCSO for 2014. This webinar is specifically designed for employers who chose to offer Excepted Benefits Health Reimbursement Accounts (HRAs) to their employees in 2014. OLSE staff will discuss the "true up" opportunity, which permits employers to bring their Excepted Benefits HRAs into compliance with the HCSO by January 30, 2015. Space is limited to 100 participants. Register now!
  • New! The Office of Labor Standards Enforcement released updated Administrative Guidance on the HCSO on October 24, 2014. The following sections are new or significantly updated: 
  • New! The San Francisco Board of Supervisors passed on the final reading an amendment to the Health Care Security Ordinance on June 17, 2014. The amendment phases in (over 3 years) a requirement that all heath care expenditures be made irrevocably and makes other changes to the HCSO. For more information, see the HCSO amendment as passed.
  • New! Health Care Expenditure Rates for 2015 are now available. As of January 1, 2015 the health care expenditure rate for large businesses (100 or more employees total) will be $2.48 per hour, and the rate for medium-sized businesses (20-99 employees total) will be $1.65 per hour.


  • 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 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 Employees  2014 Expenditure Rate  2015 Expenditure Rate
 Large All employers w/100+ employees  $2.44 per hour payable  $2.48 per hour payable
 Medium Businesses w/20-99 employees
Nonprofits w/50-99 employees
 $1.63 per hour payable  $1.65 per hour payable

Businesses w/0-19 employees
Nonprofits w/0-49 employees

 Exempt  Exempt

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

3. Post an HCSO Notice in all workplaces with covered employees.

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

  • For details about these and other requirements, see our Frequently Asked Questions, review our other resources, or contact the OLSE at hcso@sfgov.org or (415) 554-7892.
  • Employees who believe their rights have been violated may submit an HCSO Complaint Form (PDF).

 Administrative Guidance


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
P. Expenditures and Enforcement Guidance for 2014


Download all Administrative Guidance (PDF)



 Email Updates

  • Sign up for our HCSO Email List to get occasional updates about the Ordinance.

 General HCSO Resources


 Annual Reporting


 San Francisco City Option (Healthy San Francisco and Medical Reimbursement Accounts)

  • One way that employers may comply with the HCSO’s spending requirement is by making contributions to the City Option on behalf of their covered employees. Depending upon eligibility, employees who receive these contributions will receive:
    • free or discounted enrollment in the Healthy San Francisco program, or
    • a Medical Reimbursement Account to pay for out-of-pocket medical expenses.
  • Upon contributing to the City Option, employers must provide their employees with a one-time Employee Health Care Payment Confirmation (PDF) (English) (Chinese) (Spanish).
  • To learn more about contributing to the City Option, visit www.sfcityoption.org or contact City Option Program Management at employerservices@sfcityoption.org 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.

 Upcoming Administrative Hearings and Hearing Officer Decisions


 Contact Us

  • Please email hcso@sfgov.org or call 554-7892 with any questions regarding your rights and responsibilities under the San Francisco Health Care Security Ordinance.
Last updated: 12/18/2014 4:19:48 PM