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 on a quarterly basis on behalf of all covered employees (those who have been employed for more than 90 days and who regularly work at least eight hours per week in San Francisco).

As of January 1, 2024, the health care expenditure rate is $3.51 per hour. If you are eligible for an ESR, USF will contribute $3.51 per hour for each hour that you worked during the calendar quarter.

The employer contribution made by USF is directed to a SF MRA, a medical reimbursement account. Once an employee completes an enrollment form and has been approved by the City Option, the employer contribution is sent to Wageworks and deposited.  Please review this link for expenses eligible for reimbursement.

The SF MRA balance rolls over year after year. You can continue to use the account even if you no longer work at USF. However, effective March 1, 2023, the City and County of San Francisco will begin closing accounts that have not been used for three years or more starting on April 2026

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.

With your first employer contribution, you should complete the SF MRA Enrollment form.  Once approved by the City Option:

  1. You will receive an SF MRA welcome letter listing your account number and other important details.
  2. Register your account online with HealthEquity/WageWorks.
  3. Once an account is active, you can submit a claim for reimbursement with HealthEquity/WageWorks to be paid from the funds that are available in your SF MRA.

For additional questions you can contact SF City Option Customer Service at 1-877-772-0415.

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 (817) 772-0415 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 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 Official Notice.


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