Employer FAQ

Healthy Airport Ordinance (HAO)

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 into and receive the SF MRA benefit.

Health Care Security Ordinance (HCSO)

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@sfgov.org or call (415) 554-7892.

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@sfgov.org or call (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 at https://sfgov.org/olse/health-care-security-ordinance-hcso. To contact the Office of Labor Standards Enforcement with specific questions, please email HCSO@sfgov.org or call(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 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@sfgov.org or call (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 (415) 554-7892.

SF City Option Program

An employee will receive instructions with their sf city option welcome letter to complete the SF MRA Enrollment Form, either online, by mail, or by calling sf city option customer service. The form will collect information from the employee so that we can enroll them into SF MRA and deposit the employer contributions into their account. The form will also generate notifications that will go out to employees by mail and email and help them use the SF MRA account.

Your payments for each Employee are held in an employer contribution pool until the Employee contacts SF City Option to enroll INTO THE SF MRA.

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.

For detailed instructions, please visit our How to Participate in the 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 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.

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 EnglishChineseSpanish 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.

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@sfcityoption.org.

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

SF City Option offers on-site 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 Medical Reimbursement Account (SF MRA) for Employees

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.

Employees can submit receipts for eligible expenses and SF MRA claim forms online mymra.wageworks.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

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

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.

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

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.

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.

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

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.

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