San Francisco Healthcare Security Ordinance

Frequently Asked Questions

  1. What is the San Francisco Health Care Security Ordinance (HCSO)?

    The San Francisco HCSO requires Covered Employers, like USF, to satisfy an Employer Spending Requirement (ESR) by making a health care expenditure for Covered Employees when they meet the HSCO eligibility criteria.
  2. What constitutes Covered Employers and/or Covered Employees?

    For more information, please visit the San Francisco HCSO website.
  3. If I’m eligible for an ESR, where does USF make the expenditure?

    Covered employees who have medical coverage through their positions at USF receive their ESR through employer contributions for the coverage. For employees not eligible for enrollment in the University’s employer medical plans, the University remits the ESR to the City Option.

    If you have health insurance coverage, you can waive the University from making this expenditure. To do so, please refer to question number eight of this FAQ, "How do I waive?".
  4. When is eligibility assessed for an ESR?

    Eligibility for an ESR is assessed 30 days after a calendar quarter ends. New employees are not HCSO eligible during the first 90 days of employment.
  5. How much is the ESR?

    As of January 1, 2020, the health care expenditure rate is $3.08 per hour, which has increased from $2.93 per hour in 2019. If you are eligible for an ESR, USF will contribute $3.08 per hour for each hour that you worked during the calendar quarter.
  6. How do I use my ESR?

    City Option
    The ESR made by USF is directed to one of three programs within the City Option: SF MRA, SF Covered MRA, or Healthy San Francisco. If you have been notified that that you have received a contribution, please complete the SF City Option Program Finder form to determine where  your ESR and future ESR contributions should be directed. Please complete this form immediately and follow submission instructions.
  7. How will I know if I have received an ESR for the quarter?

    You will receive a payment confirmation email to your USF email address. For more information, call the City Option at (415) 615-4555 or visit the City Option web page.
  8. How do I waive the University from making this contribution?

    Employees who have employer-provided health coverage through another employer or as a dependent (i.e., a parent or spouse/partner) may complete and submit a Voluntary Waiver Form, available on the HR Forms web page. By having other coverage and by signing the waiver, USF will not be required to make an ESR on your behalf.

    If your coverage is through the USF Student Health Insurance Plan, Medicare, or Covered California, you are not eligible to waive coverage. 

    Please submit a waiver form annually via email to, via fax at (415) 386-1074, or in person at Human Resources in Lone Mountain Main 339. After submitting the voluntary waiver form, you are eligible to receive $125, which will be added to your next payroll processing as taxable income.

  9. Where can I find the HCSO HRA Official Notice?
    Visit the HR Benefits Compliance web page to view the HCSO HRA Official Notice.


If you have any additional questions about the SFHCSO, please email