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Employers in San Francisco should be aware of a rate change in the Employer Spending Requirement (ESR) effective January 1, 2024.

Which employers must comply:  An employer is covered by the Health Care Security Ordinance (HCSO) for any calendar quarter if it meets the following three conditions:

• employs one or more workers within the geographic boundaries of the City and County of San Francisco;
• is required to obtain a valid pursuant to Article 12 of the Business and Tax Regulations Code, and
• is a for-profit business with 20 or more persons performing work or a nonprofit organization with 50 or more persons performing work. This includes all persons working for the entity, regardless of whether they are located in San Francisco or outside of the city.

Businesses must meet the ESR requirements by making health care contributions on behalf of all covered employees.

A “covered employee” is an individual that has been employed for more than 90 days and who regularly works at least 8 hours per week in San Francisco.  There are exemptions for certain employees that can be reviewed by clicking .

Beginning January 1, 2024, businesses must pay the following rates:

• Employers with 100+ employees: $3.51 per hour payable (up 11 cents from 2023)
• Employers with 20-99 employees: $2.34 per hour payable (up 7 cents from 2023)
• Employers with fewer than 20 employees are exempt from the requirement
• Nonprofits with fewer than 50 employees are also exempt from the requirement

The 2024 HCSO Poster has not been released yet. For more information, please visit  directly or contact me for more information.

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information. This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.