Employer Resources

Employer FAQ

Health Care Security Ordinance (HCSO)

What is the Health Care Security Ordinance?

The Health Care Security Ordinance is a San Francisco law that requires Covered Employers to:

  • Satisfy an Employer Spending Requirement by making health care expenditures on behalf of Covered Employees;
  • Maintain sufficient records to show compliance with the Employer Spending Requirement;
  • Post an HCSO Notice at sites where Covered Employees work; and
  • Submit the Annual Reporting Form to the Office of Labor Standards Enforcement by April 30th of each year.

The HCSO is enforced by the Office of Labor Standards Enforcement. For more information about the HCSO, please visit the Office of Labor Standards Enforcement website at https://sfgov.org/olse/health-care-security-ordinance-hcso. To contact the Office of Labor Standards Enforcement with specific questions, please email HCSO@nullsfgov.org or call (415) 554-7892.

Do I need to comply with the Health Care Security Ordinance?

An Employer is covered under the HCSO if it:

  • Is a for-profit business with 20 or more employees, or a non-profit business with 50 or more employees;
  • and has employees who work in San Francisco.

For more information about Covered Employers under the HCSO, please visit the Office of Labor Standards Enforcement website at https://sfgov.org/olse/health-care-security-ordinance-hcso. To contact the Office of Labor Standards Enforcement with specific questions, please email HCSO@nullsfgov.org or call (415) 554-7892.

Which Employees are covered under the Health Care Security Ordinance?

With some exceptions, an employee is covered by the Health Care Security Ordinance if the Employee works for an Employer covered by the HCSO and:

  • Is entitled to be paid the minimum wage
  • Has been employed by the Employer for at least 90 calendar days; and
  • Works at least 8 hours per week in San Francisco.

For more information about Covered Employees under the HCSO, please visit the Office of Labor Standards Enforcement website at https://sfgov.org/olse/health-care-security-ordinance-hcso. To contact the Office of Labor Standards Enforcement with specific questions, please email HCSO@nullsfgov.org or call(415) 554-7892.

How much must I spend in health care payments to comply with the HCSO?

The minimum health care expenditure amount for each Employee is determined each quarter by multiplying the total number of hours paid to the Employee by the health care expenditure rate applicable to your company or organization. “Hours paid” include both hours worked in San Francisco by the Employee plus any paid time off, including vacation and sick days, used by the Employee.

To see the health care expenditure rate applicable to your company or organization, please visit the Office of Labor Standards Enforcement website at https://sfgov.org/olse/health-care-security-ordinance-hcso. To contact the Office of Labor Standards Enforcement with specific questions about calculating health care expenditure amounts, please email HCSO@nullsfgov.org or call (415) 554-7892.

How often must I make health care payments to comply with the HCSO?

The Health Care Security Ordinance requires that health care expenditures be made at least quarterly, within 30 days of the end of the preceding quarter.

What are my options for complying with the Health Care Security Ordinance?

Employers can comply with the Employer Spending Requirement of the HCSO through various options, including:

  • Payments for health, dental, and/or vision insurance;
  • Payments into health savings/reimbursement accounts;
  • Payments to the City Option Program.

Who do I contact for assistance with completing the HCSO Annual Reporting Form?

All questions about the Annual Reporting Form should be directed to the Office of Labor Standards Enforcement. To contact the Office of Labor Standards Enforcement, please email HCSO@nullsfgov.org or call (415) 554-7892.

SF City Option Program

What health care can my Employees receive if I make payments to SF City Option?

Employees can enroll in one of three SF City Option health care programs based on program eligibility:

  • Employees who live outside of San Francisco, are under 18, or have health insurance through an employer, spouse, parent, Medi-Cal or Medicare might be eligible for SF Medical Reimbursement Account (SF MRA) . Funds in an SF MRA may be used for eligible health care expenses, including out-of-pocket costs related to medical, dental, and vision care products and services.
  • Employees who live in San Francisco, are required by law to have health insurance, and purchase health insurance through Covered California might be eligible for SF Covered MRA. Funds in an SF Covered MRA may be used to help pay for Covered California health insurance premiums and other eligible health care expenses.
  • Employees who are uninsured, not eligible for Medi-Cal or Medicare, and live in San Francisco might be eligible to enroll in Healthy San Francisco  and receive a discount on their Healthy San Francisco participation fees.

HOW DOES THE SF CITY OPTION PROGRAM FINDER FORM WORK?

An employee will receive instructions with their SF City Option Welcome Letter to complete the SF City Option Program Finder Form, either online, by mail, or by calling SF City Option Customer Service.  The form will collect information about the employee’s household size, income, insurance status, and other demographic information, and determine their SF City Option program eligibility.  The form will also generate notifications that will go out to employees by mail and email, letting them know which program they are eligible for.

For employees eligible for SF MRA, the form will be used to enroll employees into the program.  For HSF and SF Covered MRA, eligible employees will be notified that they should call Customer Service to schedule an appointment to enroll in either program.

DOES MY EMPLOYEE GET TO CHOOSE SF MRA, SF COVERED MRA, OR HEALTHY SAN FRANCISCO AS THEIR HEALTH CARE PROGRAM?

Your Employee does not choose from the three SF City Option health care programs. After the Employee completes the SF City Option Program Finder Form, SF City Option determines whether the Employee might be eligible for SF MRA, SF Covered MRA, or Healthy San Francisco based on program eligibility rules.

How much do I have to pay to participate in the City Option Program?

You make payments on behalf of your Employees in a sufficient amount to comply with the Employer Spending Requirement of the Health Care Security Ordinance. There are no additional fees for the Employer to participate in the City Option Program.

What is the difference between City Option and Healthy San Francisco?

SF City Option is one option for Employers to satisfy the Employer Spending Requirement of the San Francisco Health Care Security Ordinance. Employees whose Employers contribute to SF City Option would be eligible for one of three SF City Option health care programs: SF MRA, SF Covered MRA, or Healthy San Francisco. Healthy San Francisco is a health access program for eligible Employees who are uninsured, not eligible for Medi-Cal or Medicare, and live in San Francisco.

How do I make City Option payments on behalf of my Employees?

For detailed instructions, please visit our Make a Payment  page.

What do I need to do when an Employee no longer works at my company?

You no longer need to include the Employee on a roster after you have completed your payment obligations under the HCSO for the Employee.

Employees with Medical Reimbursement Accounts will be able to access the funds in their MRAs and submit claims for reimbursement after they no longer work for your company. The MRA funds for those Employees do not return to you. Employees who are enrolled in Healthy San Francisco may continue in the program as long as they meet program eligibility criteria, but they might no longer receive a discount on participant fees.

Are there any special notice requirements if I make payments to the City Option Program?

Yes. After your first payment to the City Option Program on behalf of an Employee, you must provide the Employee with a Health Care Payment Confirmation Notice. You may deliver this notice to the Employee by mail, by email, or in person. The notice is available to download in English, Chinese, Spanish and Tagalog.

IF I CONTRIBUTE TO SF CITY OPTION, DO THE HCSO HEALTH REIMBURSEMENT PROGRAMS RULES APPLY?

No. If you contribute to SF City Option, you do not need to comply with the special rules that govern payments to health reimbursement programs.

Who can I contact to explain the SF City Option Program to me?

We recommend that you attend a San Francisco City Option Employer Webinar. If you have a specific question about the program, please contact City Option Program Management at (415) 615-4492 or employerservices@nullsfcityoption.org.

When is your next Employer Webinar? How can I register?

Click here to see our upcoming employer webinar dates and register for a webinar.

Can the SF City Option Program give a presentation to my Employees?

SF City Option offers on-site presentations to Employees about SF City Option health care programs and how to enroll. A minimum of 10 attendees is required for each presentation. To schedule a presentation at your company, please contact us at least 3 weeks in advance of your preferred presentation date.

Healthy San Francisco (HSF)

What is Healthy San Francisco?

Healthy San Francisco is a health care access program designed to make health care services available and affordable to uninsured San Francisco residents. Healthy San Francisco participants access primary and preventive care from their Medical Home and primary care physician. The program also provides access to specialty care, urgent and emergency care, laboratory services, inpatient hospitalization, radiology, and pharmaceuticals. For more information about Healthy San Francisco, including services covered and the provider network, please visit www.healthysanfrancisco.org.

Which Employees are eligible for Healthy San Francisco?

An Employee may qualify for Healthy San Francisco if the Employee meets all of the following requirements:

  • San Francisco resident;
  • Uninsured for at least 90 days;
  • Age 18 or over; and
  • Not eligible for public insurance programs, such as Medi-Cal or Medicare.

How does my payment for an Employee get applied to Healthy San Francisco?

If the Employee qualifies for and enrolls in Healthy San Francisco, your payment may be applied to a discount on the Employee’s quarterly Healthy San Francisco participant fee.

How much will Healthy San Francisco cost for an Employee?

Depending on your Employee’s household size and income, your Employee may be required to pay a Healthy San Francisco participant fee four times per year if your Employee is eligible for and enrolls in the program. Participant fees are based on family income level. If your Employee received an employer payment within the past six months, the Employee is eligible for a discount on participant fees. In addition to the participant fees, your Employee may pay a point-of-service Fee when your Employee receives health care services. For example, an additional fee may be paid each time your Employee visits a physician or emergency room, or picks up a prescription.  The amount of the Point of Service Fee depends on your Employee’s Medical Home and family income.

When does HSF coverage begin for an Employee after I make a payment?

An Employee’s new enrollment in Healthy San Francisco does not immediately begin upon your payment to our program. Your Employee interested in Healthy San Francisco should call Healthy San Francisco Customer Service at (415) 615-5720 to learn whether the Employee might be eligible for the program and to schedule an enrollment appointment. If your Employee qualifies for and enrolls in Healthy San Francisco, coverage begins on the date of the enrollment appointment.

What services are included in Healthy San Francisco?

Healthy San Francisco participants access primary and preventive care from their Medical Home and primary care physician. The program also provides access to specialty care, urgent and emergency care, laboratory services, inpatient hospitalization, radiology, and pharmaceuticals. For more information about Healthy San Francisco, including services covered and the provider network, please visit www.healthysanfrancisco.org.

Who can my Employees contact if they have questions about Healthy San Francisco?

Our Customer Service representatives are available Monday through Friday from 8:30am PST to 5:30pm PST to answer your Employees’ specific questions about Healthy San Francisco. Please have your Employees call us at (415) 615-5720 or email us at info@nullhealthysafrancisco.org. Employees who are deaf, hard-of-hearing, or have speech disabilities may call us on our TDD/TTY line at (415) 547-7830.

SF Medical Reimbursement Account (SF MRA)

WHAT IS A SAN FRANCISCO MEDICAL REIMBURSEMENT ACCOUNT (SF MRA)?

An SF Medical Reimbursement Account (SF MRA) is a health care account with funds that can be used for eligible health care expenses incurred by the Employee, the Employee’s spouse or domestic partner, and the Employee’s dependents. Some of the many health care expenses eligible for reimbursement are health insurance premiums, doctor’s office visits, dental services, vision services, and prescription and over-the-counter medicines.

An Employee may qualify for SF MRA if:

  • Their Employer made contributions to the SF City Option on their behalf; and
  • If the Employee meets ONE OR MORE of the following requirements:
    • Lives outside of San Francisco; and/or
    • Has health insurance from an employer, spouse, parent, Medi-Cal, or Medicare; and/or
    • Is under age 18.

Employees can submit receipts for eligible expenses and SF MRA claim forms online at mymra.adp.com or by mail, fax, or mobile app and get reimbursed by check or direct deposit with funds from the SF MRA. Learn how to submit claims for reimbursement.

Employees can still use their SF MRAs after they no longer work for the Employer who made the deposits. SF MRA funds are available to spend as long as the account is active. Employees can keep their accounts active by filing at least one SF MRA claim every 24 months. Our program will close the account and the Employee will not be able to spend the SF MRA funds if there have been no claims or deposits in over 24 months. Unused funds are irrevocable and do not return to the Employer.

If an Employee’s SF MRA is closed and they want it re-opened, they can call 1(415) 615-5720 and we’ll add the SF MRA funds back.

There is a $2.75 administrative fee subtracted from the SF MRA each month, whether or not the Employee uses the SF MRA that month.

Only health care expenses incurred on or after the effective date of the SF MRA are eligible for reimbursement. The SF MRA effective date is the payment clearance date of the Employer’s first deposit into the SF MRA

Can an Employee use the SF MRA to get reimbursed for health insurance premiums?

Yes, health insurance premiums, co-payments, and deductibles are among the many health care expenses eligible for reimbursement from SF MRAs.

WHICH EMPLOYEES ARE ELIGIBLE FOR AN SF MRA?

An Employee may qualify for SF MRA if:

  • Their Employer made contributions to the SF City Option on their behalf; and
  • If the Employee meets ONE OR MORE of the following requirements:
    • Lives outside of San Francisco; and/or
    • Has health insurance from an employer, spouse, parent, Medi-Cal, or Medicare; and/or
    • Is under age 18.

HOW DOES MY PAYMENT FOR AN EMPLOYEE GET APPLIED TO AN SF MRA?

Your payment will be deposited into an SF MRA if the employee is eligible for and enrolls in SF MRA. An Employee enrolled in SF MRA can use the funds in the SF MRA to get reimbursed for eligible health care expenses

HOW MUCH WILL AN SF MRA COST FOR AN EMPLOYEE?

There is a $2.75 administrative fee subtracted from the available funds in each SF MRA monthly, whether or not the Employee uses the account that month. Administrative fees will not be subtracted from the account if the available balance is less than $2.75.

WHEN CAN AN EMPLOYEE ACCESS THE SF MRA AFTER I MAKE A PAYMENT?

Allow 1-3 weeks after your payment posted date for your payment to be available in your Employees’ SF MRAs.

For Employees receiving their first SF MRA deposit, our program will mail account information within 1-3 weeks after they are enrolled in SF MRA.

HOW DOES AN EMPLOYEE START SPENDING THE FUNDS IN AN SF MRA?

For detailed instructions, please visit the Employee How to Access Your MRA Funds page.

WHAT EXPENSES ARE ELIGIBLE FOR REIMBURSEMENT FROM THE SF MRA?

Click here to view a detailed list of health care expenses eligible for reimbursement under the SF MRA. Doctor’s office visits, copays, health insurance premiums, eyeglasses and contact lenses, and prescription and over-the-counter medicines are among the many expenses eligible for reimbursement.

WHO CAN MY EMPLOYEES CONTACT IF THEY HAVE QUESTIONS ABOUT THEIR SF MRAS?

SF MRA Customer Service representatives are available Monday through Friday from 5:00am PST to 5:00pm PST to answer your Employees’ specific questions about Medical Reimbursement Accounts.

Please have them call SF MRA Customer Service at (866) 697-6078

SF Covered Medical Reimbursement Account (SF Covered MRA)

WHAT IS AN SF COVERED MEDICAL REIMBURSEMENT ACCOUNT (SF COVERED MRA)?

An SF Covered Medical Reimbursement Account (SF Covered MRA) is a health care spending account for Employees enrolled in a health insurance plan through Covered California. Funds in the SF Covered MRA can be used to pay for Covered California health insurance premiums and co-pays, as well as eligible health care expenses  incurred by the Employee, the Employee’s spouse or domestic partner, and the Employee’s dependents. Some of the many other health care expenses eligible for reimbursement are dental services, vision services, and prescription and over-the-counter medicines

An Employee may qualify for SF Covered MRA if their Employer made a contribution to the SF City Option on their behalf, and the Employee meets ALL of the following requirements:

  • San Francisco resident;
  • Age 18 or over;
  • Income at or below 500% of the Federal Poverty Level;
  • Required by law to have health insurance; and
  • Purchased health insurance through Covered California

The amount deposited into an SF Covered MRA is intended to cover part of the Employee’s Covered California health insurance premiums and other insurance costs such as copays and deductibles. SF City Option calculates the amount based on these factors:

  • Income;
  • Age; and
  • Start date of the Employee’s Covered California health insurance plan year

Employees can submit receipts for eligible expenses and claim forms online at mymra.adp.com or by mail, fax, or mobile app and get reimbursed by check or direct deposit with funds from the SF Covered MRA.

Employees can still use their SF Covered MRAs after they no longer work for the Employer who made the payments to SF City Option. Employees can use their SF Covered MRA to get reimbursed for eligible health care services received or health care items purchased during their Covered California plan year.  All claims must be submitted by March 31 of the next calendar year. After March 31 of the next calendar year, the SF Covered MRA funds will no longer be available for the Employee to spend.

The Employee does not have to pay any fees for having an SF Covered MRA.

An Employee can get reimbursed for eligible health care services received or health care items purchased within the Employee’s SF Covered MRA plan year. The dates the Employee is covered by the Employee’s Covered California health insurance plan is the SF Covered MRA plan year. Generally, the plan year is January 1 to December 31. If the Employee purchased health insurance through Covered California after January 1 or during a special enrollment period, the plan year might start after January 1.

CAN AN EMPLOYEE USE THE SF COVERED MRA TO GET REIMBURSED FOR HEALTH INSURANCE PREMIUMS?

Yes, health insurance premiums, co-payments, and deductibles for health insurance purchased through Covered California are among the many health care expenses eligible for reimbursement from SF Covered MRAs.

WHICH EMPLOYEES ARE ELIGIBLE FOR AN SF COVERED MRA?

An Employee may qualify for SF Covered MRA if their Employer made a contribution to the SF City Option on their behalf, and the Employee meets ALL of the following requirements:

  • San Francisco resident;
  • Age 18 or over;
  • Income at or below 500% of the Federal Poverty Level;
  • Required by law to have health insurance; and
  • Purchased health insurance through Covered California

HOW IS THE DEPOSIT AMOUNT FOR AN SF COVERED MRA CALCULATED?

The amount deposited into an SF Covered MRA is intended to cover part of the Employee’s Covered California health insurance premiums and other insurance costs such as copays and deductibles. SF City Option calculates the amount based on these factors:

  • Income;
  • Age; and
  • Start date of the Employee’s Covered California health insurance plan year

HOW MUCH WILL AN SF COVERED MRA COST FOR AN EMPLOYEE?

The Employee does not have to pay any fees for having an SF Covered MRA.

WHEN CAN AN EMPLOYEE ACCESS THE SF COVERED MRA AFTER ENROLLMENT?

Allow 1-3 weeks after the Employee enrolls in SF Covered MRA for the deposit to be available in the Employee’s account. The Employee receives one deposit per SF Covered MRA plan year.

HOW IS AN EMPLOYEE REIMBURSED FOR HEALTH CARE EXPENSES?

An Employee may submit receipts and claim forms online or by mail, fax, or mobile app and get reimbursed by check or direct deposit for expenses that are incurred during their Covered California plan year.  For detailed information, please visit the Employee Submit a Claim page.

WHAT EXPENSES ARE ELIGIBLE FOR REIMBURSEMENT FROM THE SF COVERED MRA?

Click here to view a detailed list of health care expenses eligible for reimbursement under the SF Covered MRA. Funds in an SF Covered MRA may be used to help pay for health insurance premiums and other eligible health care expenses

WHO CAN MY EMPLOYEES CONTACT IF THEY HAVE QUESTIONS ABOUT THEIR SF COVERED MRAS?

SF Covered MRA Customer Service representatives are available Monday through Friday from 5:00am PST to 5:00pm PST to answer your Employees’ specific questions about SF Covered MRA.

Please have them call SF Covered MRA Customer Service at (866) 697-6078.