The San Francisco Health Care Security Ordinance ("SFHCSO") requires Covered Employers to make certain minimum Health Care Expenditures on a quarterly basis for their Covered Employees. Those employers should take note of the new Health Care Expenditure Rates, as well as the increased salary amount for exempt managers, supervisors, or confidential employees who do not qualify as Covered Employees, both effective January 1, 2024.

Under the SFHCSO, Covered Employers must make certain minimum Health Care Expenditures on a quarterly basis for their Covered Employees.

What Covered Employers Must Do

1. Calculate and make the required Health Care Expenditures on behalf of their Covered Employees based on the following hourly rates:

   Employer Size	2024 Health Care Expenditure Rate per Covered Employee	2023 Health Care Expenditure Rate per Covered Employee
   Small Employer (For-profit: 0-19 workers; Nonprofit: 0-49 workers)	Exempt	Exempt
   Medium Employer (For-profit: 20-99 workers; Nonprofit: 50-99 workers)	$2.34 per hour ($402.48 per month maximum)	$2.27 per hour ($390.44 per month maximum)
   Larger Employer (For-profit: 100 or more workers; Nonprofit: 100 or more workers)	$3.51 per hour ($603.72 per month maximum)	$3.40 per hour ($584.80 per month maximum)

2. Maintain records of their Health Care Expenditures;
3. Post the SFHCSO poster (2024 poster anticipated to be released soon) in all workplaces with Covered Employees and distribute a copy to remote Covered Employees; and
4. Submit the SFHCSO Annual Reporting Form (2024 Annual Reporting Form anticipated to be released soon) to OLSE by April 30, 2024.

Which Employers Are Covered?

As a reminder, the SFHCSO applies to:

Covered Employers who:

• Employ one or more Covered Employees in the City or County of San Francisco;
• Are required to maintain a valid San Francisco business registration certificate under Article 12 of the Business and Tax Regulations Code; and
• Are for-profit medium (20-99 workers) to large (100 or more workers) employers or are nonprofit employers with 50 or more workers. The number of "workers" includes all persons working for the entity, regardless of whether the workers are located in San Francisco or outside of the City.

Covered Employees who:

• Work for a Covered Employer within the City or County of San Francisco for at least eight hours per week on average during the calendar quarter;
• Are entitled to be paid the minimum wage;
• Have worked for the Covered Employer for at least 90 calendar days; and
• Do not fall into any of the following categories of exempt employees:
  • Employees who waive their right to have their Covered Employer make the Health Care Expenditures on their behalf;
  • Employees who qualify as managers, supervisors, or confidential employees AND earn more than the salary exemption amount (which, as of January 1, 2024, is $121,372 annual salary/$58.35 hourly salary);
  • Employees who are eligible for Medicare or TRICARE;
  • Employees who are employed by a nonprofit corporation for up to one year as trainees in a bona fide training program; and/or
  • Employees who receive health care under the San Francisco Health Care Accountability Ordinance.

What Are Health Care Expenditures?

Health Care Expenditures are generally defined as:

• Any amount paid by a Covered Employer to its Covered Employees, or to a third party on behalf of its Covered Employees, for the purpose of providing or reimbursing the cost of health care services for Covered Employees and/or their spouses, domestic partners, children, or other dependents; and
• An amount paid by a Covered Employer to the City of San Francisco on behalf of a Covered Employee to establish his or her eligibility to participate in the City's Health Access Program.Compliance with the SFHCSO can be complicated!

Please visit the SFHCSO's official website to determine whether you must comply with the SFHCSO.

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