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 those coverages. For employees not eligible for enrollment in the University’s medical plans, the University remits the ESR to the City Option. Prior to 2017, the ESR was split between two plans: the HCSO Reimbursement Plan and the City Option.

    If you have health insurance coverage, you can waive the University from making this expenditure. To do so, please refer to the "How do I waive coverage?" FAQ below.
  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, 2018, the health care expenditure rate is $2.83 per hour, which has increased from $2.64 per hour in 2017. If you are eligible for an ESR, USF will contribute $2.83 per hour for each hour that you worked during the calendar quarter.
  6. For 2016 ESR contributions, how was the ESR split between the HCSO Reimbursement Plan and the City Option?

    In 2016, 20% of the total ESR earned each quarter was directed to the HCSO Reimbursement Plan, and the remaining 80% was directed to the City Option. In 2015, 40% of the total ESR earned each quarter was directed to the HCSO Reimbursement Plan, and the remaining 60% was directed to the City Option. As of 2017, 100% of the ESR is directed to the City Option.
  7. How do I use my ESR?

    City Option (2017 – current)
    As of 2017, 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. You will receive a 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.

    HCSO Reimbursement Plan (before 2017)
    Prior to 2017, a portion of your ESR was was directed to the HCSO Reimbursement Plan. Administered by BASIC pacific, this plan is a Limited Purpose – or excepted benefit – Health Reimbursement Account (HRA), which limits eligible expense reimbursements to the following:

    *Dental benefits limited to treatment of the mouth
    *Vision benefits limited to treatment of the eye
    *Long-term, nursing home, home health, or community-based care premiums

    For more HCSO plan and contact information, including when funds expire, please review the following documents:

    Available on the HR Forms web page:

    *HCSO HRA Claim Form
    *HCSO HRA Direct Deposit Form
    *HCSO HRA Complete Employee Packet (current enrollees)
    *HCSO HRA Welcome Packet (new enrollees)
    *HCSO HRA Qualified Expenses - Dental/Vision/LTC Excepted Benefit

    Available on the Compliance Information web page:
    *HCSO HRA Official Notice
    *HCSO HRA Summary Plan Description 

    BASIC pacific's contact information:
    Phone: (800) 574-5448 
    Fax: (800) 584-4591
  8. 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.
  9. How do I waive coverage?

    Employees who have employer-provided health coverage as either an employee of another company or as a dependent of another person (i.e., a parent or spouse/partner) may complete and submit a Voluntary Waiver Form. By having other coverage and by signing the waiver, USF will not be required to make an ESR on your behalf. If you only have the USF Student Health Insurance Plan, 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.


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