San Francisco Healthcare Security Ordinance (SF HCSO)

The city of San Francisco instituted an ordinance in 2008, referred to as the San Francisco Health Care Security Ordinance (SF HCSO), which requires certain employers to provide health benefits for employees who work within the city or county of San Francisco.

How the SF HCSO Works

Under the SF HCSO certain employers must satisfy an “employer spending requirement” by making required healthcare expenditures every quarter based on payable hours.  Please see the chart below to see if your client’s company is required to comply with the SF HCSO and the expenditure rates for each employer size.

Employer Size Number of Workers 2020 Expenditure Rate 2021 Expenditure Rate
LARGE All employers with 100+ workers $3.08 per payable hour $3.18 per payable hour
MEDIUM Business with 20-99 workers
Non-profits with 50-99 workers
$2.05 per payable hour $2.12 per payable hour
SMALL Business with 0-19 workers
Non-profits with 0-49 workers
Exempt Exempt

To assist employers in complying with the city’s requirements, ASi implements and assists with the ongoing administration of Health Reimbursement Arrangements (HRAs) which provide certain health benefits to eligible employees.  Please visit the SF HCSO website for detailed information about employer requirements.

San Francisco HCSO Compliant Plans with ASi

ASi offers three types of plans that comply with the San Francisco Health Care Security Ordinance (SF HCSO).

Health Reimbursement Arrangements (HRAs)

HRAs allow your client to help offset their employees’ out-of-pocket healthcare expenses. An HRA is not a health insurance. Instead, it is an account that your client funds which offers their employees an allowance of tax-free money. When your client’s employees purchase eligible healthcare related expenses, they can submit a claim to ASi, which allows the HRA to reimburse them up to their allowance amount. The SF HCSO HRA compliant plan’s funding falls under Irrevocable HRA Funding. Irrevocable funding means that once the employer has paid ASi funds for the HRA, monies cannot be revoked and will remain available to employees even after employee termination.

Integrated HRA – An Integrated HRA (IHRA) is intended to accompany an employer sponsored group health plan. An Integrated HRA allows for medical expenses and prescription medication.  Enrollment for this plan requires an employee to be enrolled in a group medical plan, either through your client’s company or another employer’s group plan.

Excepted Benefits HRA – An Excepted Benefits HRA (EBHRA) will allow reimbursement for eligible dental and vision expenses, as well as long-term care benefits, nursing home, home health, community-based care, and coverage limited to a specific disease or illness.

Your client can offer both the Integrated HRA and EBHRA options to their employees.

Specialized Insurance Plans

Limited Medical Plans – Group Limited Indemnity insurance provides coverage for a select set of benefits, such as inpatient hospitalization and ER visits for injury. Benefits for each covered medical service are paid at a specified amount per day, to a maximum number of days per year. NOTE: Group Limited Indemnity is not major medical insurance.

Telehealth Programs – A Telehealth Program provides participants an alternative way to speak with a doctor about basic health concerns. Telehealth programs are meant to reduce time spent in urgent care, provide easy, convenient services, and maximize participant time.  Telehealth programs are one of the rising products employers are offering to their employees.

Fully Insured Dental and Vision Plans – ASi’s flexible managed dental and vision fee for service programs and Ameritas PPO Network have proven to be cost effective alternatives to traditional dental and vision insurance plans.

For more information about our Specialized Insurance SF HCSO plans, please email

What Expenses Are Eligible?

The following is a general listing of the eligible expenses covered under the EBHRA:

  • Dental – Expenses due to the prevention and alleviation of dental disease. Preventive treatment includes the services of a dental hygienist or dentist for such procedures as teeth cleaning, the application of sealants, and fluoride treatments to prevent tooth decay. Treatment to alleviate dental disease include services of a dentist for procedures such as X-rays, fillings, braces, extractions, dentures, and other dental ailments. Anything considered cosmetic is not a covered expense.
  • Vision – Expenses for treatment of the eye (i.e. prescription glasses, contacts, exams, office visits, etc.)
  • Long-term care benefits
  • Nursing home, Home health, Community-based care
  • Coverage limited to a specific disease or illness

The following is a general list of eligible expenses under the IHRA.  For a complete list, please visit the IRS Code Section 213(d). To view or print the PDF of ASi’s general list of eligible expenses, please review our Integrated HRA Qualifying Expenses PDF.

  • Preventative Fees
  • Diagnostic Fees (x-rays, blood tests, lab tests, exams)
  • Prescription Fees (including insulin treatments and some OTC medications)
  • Prenatal and Postnatal Care
  • Hospital Care
  • Specialist Care (Chiropractic, Gynecology, Neurology, Podiatry, Physical Therapist, Surgeons, etc.)
  • Mental Health
  • Vision Expenses
  • Dental Expenses

Employer Features

Your clients become part of the ASi family, which means providing them with the best features within the industry. The features listed below are included as part of our administrative services.

  • An Alternative to Using the San Francisco City Option for Compliance
  • Online Portal
  • Customizable Benefit Plan and Materials
  • Assist in Plan Design, including Plan Design Options and Features
  • Draft Plan Documents, Summary Plan Description, Corporate Resolution, and Adoption Agreement
  • Assist with Annual Reporting That is Due to the OLSE
  • Dedicated ASi Teams Who Provide Personalized Customer Service
  • Informative Resources for Employees
  • OLSE Audit Assistance
  • Task Reminders and Quarterly Emails
  • Assist in Preparing the Annual Reporting
  • Provide Quarterly Template for Quarterly Submission
  • Analyze and Review Quarterly Submission
  • Provide Quarterly Statements for Participants
  • Provide Quarterly Plan Summary
  • Prepare Separation Notices for Terminated Employees
  • Process Claims Daily
  • Generate Reimbursement Checks Weekly

Participant Features

We know your client’s employees are the heart of their business, which means we provide them with great tools and resources to help them manage their benefits.

  • Online Employee Portal
  • Online Claim Submission
  • Easy to Understand Benefits Breakdown

Want to Know More About this Service?

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Phone: 866-777-1320 or 559-256-1320