The San Francisco Health Care Security Ordinance (HCSO) is a local ordinance that uniquely applies to employers with workers in the city of San Francisco. The HCSO requires employers to make certain health care expenditures—claims paid under an insurance plan—on behalf of their San Francisco-based employees. To the surprise of many employers, the HCSO also applies to remote workers who reside in San Francisco even if the employer has no other presence in or connection to the city of San Francisco.

Is Your Company a ‘Covered Employer’ Under the HCSO?

The HCSO applies to for-profit employers with 20 or more employees worldwide and nonprofit employers with 50 or more employees worldwide, if the company:

1. Has one or more employees who work within the boundaries of San Francisco proper.

2. Is required to obtain a license to do business in San Francisco.

Here are some tips for compliance with the HCSO:

• The number of employees also includes those employed by members of the same controlled group of companies.
• If the employer has even one remote worker in the city of San Francisco, it is required to obtain a license to do business in San Francisco.

Which Employees Are Entitled to the Expenditures?

The HCSO requires that covered employers make health care expenditures on behalf of employees who:

1. Are entitled to be paid at least the minimum wage.
2. Have been employed for at least 90 calendar days.
3. Perform at least eight hours of work per week within San Francisco’s geographic...

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