San Francisco: Health Care Ordinance Updates

As a follow-up to our November 2008 Benefit Beat article, San Francisco’s Health Care Ordinance Challenged Again, the Court of Appeals denied the GGRA's request for a rehearing en banc on March 9, 2009. Thus, the employer spending requirement of San Francisco’s Health Care Security Ordinance continues to be in effect. 

Expenditure Rates for 2010

Covered employers who are subject to San Francisco’s Ordinance are required to make health care expenditures (HCE) to, or on behalf of, their covered employees.  These expenditure amounts are adjusted annually, in accordance with the San Francisco Ordinance.

Health Care Expenditure Rate - Per Hour



January 1, 2009


January 1, 2010

Employer with 100+ Employees



Employer with 20 – 99 Employees



Examples of Qualifying Health Care Expenditures

A Covered Employer has a choice as to the type of health care expenditure it chooses to make for its Covered Employees, including the following:

  • Payments to a third party to provide health care services, such as health insurance premium.

  • Payments to the City to fund membership in the Health Access Program/Healthy San Francisco; or to set up a medical reimbursement account for health care expenses.

  • Contributions to a health spending account, such as a health reimbursement arrangement, a flexible spending account, or a health savings account.

  • Cash reimbursements for expenses incurred in the purchase of health care services.

  • Costs incurred in the direct delivery of health care services, such as paying a health care provider directly.

In addition, the Office of Labor Standards has recently revised its collection of Frequently Asked Questions relating to the Employer Spending Requirement.


The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations.

As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained in this Benefit Beat is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.

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