San Francisco Healthcare Security Ordinance

Frequently Asked Questions

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.

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 through another employer plan, you can waive the University from making this expenditure. Please see FAQ number eight on this page.

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

As of January 1, 2022, the health care expenditure rate is $3.30 per hour, which has increased from $3.18 per hour in 2021. If you are eligible for an ESR, USF will contribute $3.30 per hour for each hour that you worked during the calendar quarter.

The ESR made by USF is directed to a SF MRA, a medical reimbursement account. Once an employee completes an enrollment form and has been approved, the employer contribution is deposited into the SF MRA. The SF MRA balance rolls over year after year. You can continue to use the account even if you no longer work at USF.  The employee's eligible healthcare expenses, as well as those for their spouse or domestic partner, and dependents, can be reimbursed through their SF MRA.

Employees are mailed the SF MRA Enrollment form along with the Welcome Letter after the first employer contribution.  If you don’t receive the SF MRA Enrollment Form, it is accessible on the SF City Option website or by calling SF City Option Customer Service at 415-615-5720.

You will receive a payment confirmation email to your USF email address. In addition, if it’s your first contribution you will be mailed a SF MRA Enrollment Form and welcome letter from the City Option. For more information, call the City Option at (415) 615-4555 or visit the City Option web page.

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 or via fax at (415) 386-1074. After submitting the voluntary waiver form, you are eligible to receive $125, which will be added to your next payroll processing as taxable income.

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