Employer FAQ

The Healthy Airport Ordinance (HAO), an amendment to the Health Care Accountability Ordinance, is a San Francisco law that requires Covered Employers at San Francisco International Airport to provide health insurance that meets the compliance requirements at no cost to the QSP employee or pay a specified amount on behalf of the employee to SF City Option.

The Healthy Airport Ordinance is an amendment to the Health Care Accountability
Ordinance (HCAO), but it applies only to employees covered by SFO’s Quality Standards Program (QSP), adopted by the San Francisco Airport Commission. Employers may contact SFO’s Office of Social Responsibility and Community Sustainability at 1(650) 821-1003 or qsp@flysfo.com to determine if they have employees covered by the QSP.

Employers that choose to comply with the Amendment by making the specified contribution on the covered employee’s behalf to the City Option Program must make these contributions to SF City Option Program by the 15th of each month for hours worked in the preceding month.

Under the Healthy Airport Ordinance, once SF City Option receives and processes an employer contribution for an employee, the employee can enroll in the SF MRA program and receive their benefit.

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. To contact the Office of Labor Standards Enforcement with specific questions, please email HCSO@sfgov.org or call 1(415) 554-7892.

An employer is covered under the HCSO if it:

• Is a for-profit business with 20 or more employees worldwide, or a non-profit business with 50 or more employees worldwide;
• 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. To contact the Office of Labor Standards Enforcement with specific questions, please email HCSO@sfgov.org or call 1(415) 554-7892.

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. To contact the Office of Labor Standards Enforcement with specific questions, please email HCSO@sfgov.org or call 1(415) 554-7892.

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. To contact the Office of Labor Standards Enforcement with specific questions about calculating health care expenditure amounts, please email HCSO@sfgov.org or call 1(415) 554-7892.

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.

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

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@sfgov.org or call 1(415) 554-7892.

When an employer pays into SF City Option for the first time, their employee will receive a welcome letter. In the welcome letter they will receive instructions for completing the SF MRA Enrollment Form. They can complete the form online, mail it, or by calling Customer Service at 1(877) 772-0415.

Once the SF MRA Enrollment Form is processed, the employer contributions are deposited into the employee’s SF MRA account. The employee will receive notifications by mail and email so they use their SF MRA account.

Employer payments to SF City Option may provide the employee with a medical reimbursement account.

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 or Healthy Airport Ordinance. There are no additional fees for the Employer to participate in the City Option Program.

For detailed instructions, please visit our How to Participate in the SF City Option page.

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

You no longer need to include the employee on a roster after you have completed your payment obligations under the HCSO or HAO 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 do not return to the employer.

Now that your SF City Option roster is paid, it’s important that you inform your employees about this benefit so that they take the steps to enroll into the SF MRA and use the money you have contributed on their behalf. We recommend that you display the SF City Option Poster in a break room or post it virtually in your HR or benefits portal.

Additionally, provide the one-page handout ‘Welcome to SF City Option’ and the Health Care Payment Confirmation Notice to your employees in person, by email, text or mail to help get them ready to enroll.

All of the educational materials are available to download in English, Spanish, Chinese and Tagalog.

You can also schedule to have SF City Option come to your site to educate and help to enroll your employee enroll into their SF MRA benefit.

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.

Download in English, Chinese, Spanish and Tagalog.

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.

If you have questions about the program, please contact SF City Option Program Management at 1(415) 615-4492 or employerservices@sfcityoption.org.

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

SF City Option offers on-site and online presentations to Employees about SF City Option 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.

SF City Option gives hard-working people who are employed in San Francisco access to funds to get reimbursed for health insurance and other health-related expenses. The ultimate goal of the SF City Option and SF MRA program is to help participants achieve and maintain their best health and wellness by providing funds to help with health-related expenses.

The SF MRA program gives you access to funds to get reimbursed for health insurance and other health-related expenses. Your spouse, domestic partner, and any dependents can also access these funds.

Notes About the Program:

San Francisco Medical Reimbursement Account, also known as SF MRA, is a health program the City and County of San Francisco created in 2005. The goal of the program is to make sure that participants can get reimbursed for health-related expenses, including health insurance premiums and deductibles.

As of January 2022, SF MRA has paid out over $500 million to participants to help them cover health-related expenses and help them maintain excellent physical and mental health.

Money from SF MRA can be used for a wide range of medical expenses, services, and products.

SF MRA funds provide reimbursement for health and medical expenses, services, and products for:

• You (known as a ‘participant’ in the SF MRA program).
• Your spouse or domestic partner.
• Your children or dependents.

Enrollment takes place by filling out a form online or by mail. Reimbursement takes 3-5 business days. A separate company, WageWorks/HealthEquity, handles reimbursement. Reimbursement takes place by direct deposit to your bank account or by check.

Funding for SF MRA comes from your employer.

You can use your SF MRA funds to get reimbursed for health insurance and insurance deductibles. Have you been putting off a visit to a doctor, dentist, optometrist, or medical professional? Use your SF MRA to get reimbursed for this visit and gain peace of mind knowing you’re improving your health.You can use SF MRA for mental health-related expenses.

Why does the SF MRA program exist?

To help participants maintain great health and to make people who work in San Francisco the healthiest in the United States. You can use your money from SF MRA to help prevent medical issues through routine check-ups and preventative products and services. The money in your active account remains available to you, even if you leave your employer. Your medical history remains confidential.

Accident or unexpected medical expense?

Use your SF MRA funds. You can even use your SF MRA funds for prescriptions, over-the-counter medicines, and dietary supplements.

Accounts remain active as long as there is at least one SF MRA claim every 3 years. Beginning March 1, 2023, the City and County of San Francisco will have a policy to close accounts that haven’t been used for three years. If you don’t enroll by April 2026, your account will be permanently closed.

Yes, your SF MRA can be used to provide reimbursement for health insurance premiums, co-payments, and deductibles.

Employees are eligible for an SF MRA if their Employer made contributions to SF City Option on their behalf and those contributions are deposited into an SF MRA once they enroll.

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, plus prescription and over-the-counter medicines are among the many expenses eligible for reimbursement.

The San Francisco Health Commission approved a policy in January 2022 to permanently close employee accounts that have not been used for a 3-year consecutive period. Any funds in those account will also be permanently reverted to the City and County of San Francisco. This policy is consistent with existing state law (Government Code 50050).

The policy is effective March 1, 2023. That means the SF City Option program will begin tracking accounts that have had no activity for a three-year consecutive period beginning March 1, 2023, and beyond. The earliest any accounts could potentially be permanently closed is April 2026.

To learn more about this policy, Click here.

SF City Option Customer Service representatives are available to answer employee questions Monday through Friday from 8:30am PST to 5:30pm PST. The number is 1(877) 772-0415.