Who is covered by the San Francisco, CA Health Care Accountability Ordinance?
The San Francisco Healthcare Accountability Ordinance (HCAO) applies to most City contractors and tenants, including those at the San Francisco International Airport, the Port of San Francisco, and the San Bruno Jail.
- The HCAO applies only to Contractors with at least $25,000 ($50,000 for non-profit organizations) in cumulative annual business with a City department(s).
- Employees are covered if they work for a covered contractor or tenant with 20 or more employees (for profits) or 50 or more employees (nonprofits) (including employees or any parent or subsidiaries) and work at least 20 hours or more per week on a City contract for services or services on property leased from the City.
- The HCAO also applies to the employees of subcontractors and subtenants of the City contractor or tenant.
What does the law require?
The HCAO requires employers to offer one of the following to every covered employee (those that work 20 or more hours per week):
- health plan that meets the minimum standards outlined by the Director of Public Health where the employer pays 100% of the premium, or
- pay a specified hourly rate for each hour worked by a covered employee to the City and County of San Francisco for use by the Department of Public Health (SF General Hospital), or
- under limited circumstances, pay a specified hourly rate for each hour worked by a covered employee directly to the covered employee. The employee must live outside of San Francisco and work on a City contract outside of San Francisco.
Payments to SF General Hospital are subject to weekly maximum. The hourly rate and weekly maximum expenditure rates are adjusted each year for inflation, effective on July 1.
Who must post the San Francisco Health Care Accountability Ordinance Poster?
Contracting parties must post the San Francisco Health Care Accountability Ordinance Poster in a conspicuous place at any job site where any covered employee works and where work under a covered 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. Contractors must also provide the HCOA Know Your Rights form to all covered employees and obtain their signature acknowledging receipt of the form. Employers must maintain copies signed by employees.