Employers contracting with the City and County of San Francisco to perform services or construct public improvements are subject to the Health Care Accountability Ordinance (HCAO). The HCAO requires an employer to either:

• Offer a compliant health plan that meets minimum standards with no premium charge to the covered employee, or  
• Pay $6.35 (indexed) per hour (capped at $254 per week) to City and County of San Francisco, or  
• Pay $6.35 (indexed) per hour to a covered employee. 

The pay rate is adjusted annually on July 1. The current rate is for the period July 1, 2023 – June 30, 2024. The minimum standards for a compliant health plan for 2024 can be found here. 2023-2024 minimum standard FAQs can be found here.

A covered employee is an individual who works at least 20 hours a week on a city contract. A covered employee must sign a Know Your Rights form acknowledging his/her rights under the HCAO. A covered employee may also voluntarily waive his/her right to have health coverage. The waiver form can be found here. An employer must keep a signed copy of both forms.

Employers must post an HCAO poster in a conspicuous place at any workplace or job site where any employee works and where work under a contract is performed. The posting must be in English, Spanish, Chinese, and any other language spoken by at least five percent of the employees at the workplace or job site.

This ordinance is similar to but distinct from the Health Care Security Ordinance, see prior HCSO Benefit Beat article here.

The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. This information is provided as general guidance and may be affected by changes in law or regulation. This information is not intended to replace or substitute for accounting or other professional advice. You must consult your own attorney or tax advisor for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.