Glossary of Terms

Glossary of Terms

Affordable Care Act: The Patient Protection and Affordable Care Act (ACA) is a federal law passed in 2010 aimed at reforming the health care system. The purpose of the law was to expand access to high-quality affordable health insurance. In California, this included the creation of a new health insurance marketplace called Covered California and the expansion of California’s public health insurance program called Medi-Cal.

Certified Application Assistor (CAA):  An individual trained and certified to enroll people in Healthy San Francisco.

City Option: The City Option Program is one option for Employers to satisfy the Employer Spending Requirement of the San Francisco Health Care Security Ordinance (HCSO).

Covered California: Covered California is a health insurance marketplace that allows Californians to compare, choose, and enroll in health insurance plans. Individuals with household income between 138% and 400% of the Federal Poverty Level may be eligible for tax credits to help make their health insurance more affordable. Eligible employees who receive contributions from their employers through SF City Option and purchase health insurance through Covered California may be eligible for premium and cost sharing subsidies through the SF Covered MRA program.

Covered Employee: An Employee is covered under the Health Care Security Ordinance if the Employee works for a Covered Employer and (1) is entitled to be paid the minimum wage, (2) has been employed by the Employer for at least 90 calendar days, and (3) works at least 8 hours per week in San Francisco.

Covered Employer: An Employer is covered under the Health Care Security Ordinance if it: (1) is a for-profit business with 20 or more employees or a non-profit business with 50 or more employees, and (2) has employees who work in San Francisco.

Eligible Health Care Expenses: Health care expenses that are eligible for reimbursement from an SF MRA or SF Covered MRA.

Employee Health Care Payment Confirmation: The Health Care Security Ordinance requires Employers participating in the City Option Program to provide an Employee with an Employee Health Care Payment Confirmation Notice after the Employer’s first payment to the City Option Program on behalf of the Employee.

Employer Spending Requirement: The Employer Spending Requirement of the Health Care Security Ordinance requires that a Covered Employer make minimum health care expenditures for each Covered Employee. The minimum health care expenditure amount is determined quarterly by multiplying the total number of hours paid to the Employee by the applicable health care expenditure rate.

Employer Portal: The Employer Portal is a web application for Employers participating in the City Option Program to submit rosters that identify the Employees who will  have health care payments applied on their behalf.

Federal Poverty Level: A measure of income level issued annually by the U.S. Department of Health and Human Services. Federal poverty levels are used to determine a person’s eligibility for certain programs and benefits, such as Medi-Cal and tax credits through Covered California.

Health Access Program: A program that provides the uninsured with access to affordable health care services. It is NOT insurance.

Health Care Reform: Enacted in March 2010, the federal Patient Protection and Affordable Care Act (also known as the Affordable Care Act (ACA) or “Obamacare”) provides policies, regulations and guidelines for implementation of comprehensive health care reform within the U.S. The Affordable Care Act is intended to expand access to high-quality, affordable health care.

Health Care Security Ordinance: The San Francisco Health Care Security Ordinance (HCSO) requires Covered Employers to satisfy an Employer Spending Requirement by making health care expenditures for their Covered Employees, among other reporting and notice requirements. The San Francisco Office of Labor Standards Enforcement is responsible for enforcing the employer requirements of the HCSO.

Health Insurance: A contract that requires a health insurer to pay some or all of a health insurance plan member’s health care expenses in exchange for a premium.

Healthy San Francisco: A health access program created by the City and County of San Francisco that provides accessible and affordable health care services for eligible uninsured San Francisco residents.

Healthy San Francisco Enrollment Site: The San Francisco location where a Healthy San Francisco Participant meets with a Certified Application Assistor (CAA) to complete an application to enroll in Healthy San Francisco.

ID Card: A card carried by a Healthy San Francisco participant that lets the participant’s Medical Home and other health care service providers know that the participant is enrolled in Healthy San Francisco.

Medi-Cal: California’s Medicaid health care program. This program provides free health insurance for children and adults with limited income who meet eligibility requirements.

Medical Home: The facility where a Healthy San Francisco participant receives primary and preventive health care services, and referrals to specialty health care providers.

Medical Reimbursement Account: Funds in a Medical Reimbursement Account (MRA) 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 health care expenses eligible for reimbursement are health insurance premiums (including health insurance purchased through Covered California and other health insurance marketplaces), doctor office visits, dental services, vision services, and prescription and over-the-counter medicines. The SF City Option program offers two types of MRA programs, the SF MRA and SF Covered MRA.

MRA Claim: An Employee with a Medical Reimbursement Account may submit claims for reimbursement of eligible health care expenses.

Office of Labor Standards Enforcement: The San Francisco Office of Labor Standards Enforcement is responsible for enforcing the Employer requirements of the Health Care Security Ordinance.

Participant Fees: Depending on the Healthy San Francisco participant’s household size and income, the participant may be required to pay a quarterly fee to remain enrolled in Healthy San Francisco.

Point of Service Fees: Depending on the Healthy San Francisco participant’s Medical Home and income, the participant may be required to pay a point of service fee when the participant accesses services.

San Francisco Department of Public Health (SFDPH): SFDPH is a government entity run by the City and County of San Francisco. San Francisco Health Plan is the third party administrator of SF City Option, SF MRA, SF Covered MRA, and Healthy San Francisco on behalf of SFDPH.

SF City Option Program Finder Form: The form used by Employees whose Employers have made payments on their behalf to SF City Option to determine whether they might be eligible for one of three SF City Option health care programs: SF Covered MRA, SF MRA, or Healthy San Francisco.

SF Covered MRA: A program from the City and County of San Francisco that helps make health insurance more affordable for eligible SF residents who purchase insurance through Covered California. Employees with employer contributions to SF City Option on their behalf 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 health insurance premiums and other eligible health care expenses.

SF MRA: A program from the City and County of San Francisco that allows eligible employees to get reimbursed for their and their family’s eligible health care expenses. Employees with employer contributions to SF City Option on their behalf who live outside of San Francisco, are under age 18, or have health insurance through an employer, spouse, parent, Medi-Cal, or Medicare might be eligible for 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.