HCAO compliance requires a service agreement with the City and County of San Francisco, or a lease at SFO or the Port of San Francisco, and includes subcontractors and subtenants under the agreement or lease. The contract or lease must be at least $25,000 per year (for non-profit employers he is $50,000). Eligible employers include for-profit employers with 20 or more of his employees worldwide (50 or more for non-profit employers). Eligible employees include all employees who work 20 or more hours per week for a covered employer on a contract or lease covered by HCAO.
San Francisco contractors and tenants must provide free, minimal health benefits to covered employees under HCAO and HAO.
The HCAO requirements should not be confused with the San Francisco Health Security Ordinance (HCSO), which applies to employees (including remote workers) working in the city and county of San Francisco. For more information on HCSO, see San Francisco Health Care Expenditure rates for 2023, released August 8, 2022.
San Francisco Public Health’s new HCAO minimum standards require plans to cover all services listed in California’s current Essential Health Benefits (EHB) Benchmark Plan (CA Benchmark Plan). This standard applies to employee-only coverage and does not require dental or vision benefits. The Office of Labor Standards Enforcement (OLSE) has also released an updated poster. This has required employers to display it prominently at each San Francisco workplace for several years.
Changes to the 2023 standard relate to cost sharing, including coinsurance, copayments, deductibles and copayment caps. Non-calendar year plans are not required to comply with the 2023 standard until the first day of the plan year beginning in 2023. See baseline chart for 2023 below.
Employers must annually obtain approval for an HCAO Know Your Rights Notice (also recently updated) signed by an eligible employee. Employees may waive their right to indemnity by signing an approved waiver form. The employer must retain her notice and waiver for four years after the applicable contract expires. All notices and posters must be available in English, Spanish, Chinese, and other languages spoken by at least 5% of her workplace or field employees. Templates are also available in Filipino.
2023 base chart
In addition to covering EHB, contractor health plans must comply with these 16 criteria (changes are bold):