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Baldwin Bulletin

San Francisco HCAO Rates Increase Effective 7/1

The Baldwin Group
Updated: July 8, 2024
1 minute read

Effective July 1, 2024, the Health Care Accountability Ordinance (“HCAO”) Fee Rate will increase to $6.75 per hour with a weekly maximum cap of $270.  Updated posters and forms are available on the HCAO Webpage.

The San Francisco HCSO requires covered employers to make a specified amount of health care expenditures for covered employees. Employers generally satisfy the health care expenditures through a combination of the employer-share of the premium for the health plan, Health Savings Account (“HSA”) contributions, and City Option contributions. Aspects of the HCSO are not intuitive for employers—including the requirement to make City Option contributions for certain employees who declined the health plan and the eight-hour per week covered employee threshold.

Employer Action Items

The HCSO generally requires employers with 20 or more employees (50 or more for non-profits) to make a minimum level of health care expenditures for employees performing at least eight hours of work per week in San Francisco.

An employer is covered by the HCSO for any calendar quarter if it meets the following three conditions:

  • Employs one or more workers within the geographic boundaries of the City and County of San Francisco;
  • Is required to obtain a valid San Francisco business registration certificate pursuant to Article 12 of the Business and Tax Regulations Code; and
  • Is a for-profit business with 20 or more persons performing work OR a nonprofit organization with 50 or more persons performing work.

The SF HCSO does not apply to employers who do not need to obtain a valid San Francisco business registration certificate.


Effective July 1, 2024, covered employers who make payments to San Francisco General Hospital to satisfy the requirements of the HCAO must pay $6.75 per hour, capped at $270.00 per work week.

This rate is adjusted for inflation annually on July 1.

For More Information

For more information, please see the San Francisco HCSO web page or the San Francisco City/County FAQ document.

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