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The “City Option”

One choice for complying with the Health Care Security Ordinance

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San Francisco requires businesses to spend money on health care for their employees

• How much you must pay depends on:

• the number of total employees you have; and

• the number of hours for which each San Francisco employee is paid

• City’s Office of Labor Standards Enforcement (OLSE) has more information on this:

www.sfgov.org/olse/hcso

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Health insurance is the best thing to purchase with the health care dollars

• As an employer, you get to choose how to spend the required health care dollars

• Best option is insurance

• Most comprehensive benefit

• Important to your employees’ physical and financial health

• We do not recommend that you drop health insurance to choose the City Option

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There are other options for complying with the HCSO.

If you cannot provide health insurance, other choices include:

• Dental or vision insurance

• Various types of health savings accounts

• Reimbursement of health care expenses

• Other options your broker may recommend

Another option is paying money to the City – the “City Option”

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Health Insurance

Dental

Vision

Health SavingsAccounts

Reimbursement of Health Care

Expenses

City Option

ESREmployer Spending Requirement

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City Option

Medical Reimbursement

Accounts

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You can put money into the City Option on any frequency for any employees

• City Option has no minimums and no maximums

• You can pay money • At any time*

• On any frequency schedule you prefer*

• For any employees*

• In any amount*

* It is your responsibility to make sure you comply with HCSO requirements.

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The City Option has two components: Healthy San Francisco and Medical Reimbursement Accounts

When you send money to the City, your employees are sorted into two categories

1. Employees are assigned to Healthy San Francisco (HSF) who:

• Live in San Francisco

• Uninsured; and

• 18-64 years old

2. All other employees are assigned to Medical Reimbursement Accounts (MRA)

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Once you put money into City Option, your employee will be told which category s/he falls into

Each employee will be sent a letter telling him/her what to do

• How to access money in MRA

• Web access or paper

• How to apply for HSF

• Make an appointment

• Bring all relevant documents

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MRAs are individual accounts your employee may use to pay for medical expenses

• Employee can use $ in Medical Reimbursement Account to get reimbursed for medical expenses, e.g.

• Doctor, hospital, other medical bills

• Dental and vision expenses

• Insurance premiums

• Reimbursement is limited to amount of money in employee’s MRA at time bill is submitted

• $4 monthly fee is deducted from the account

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HSF gives your employee access to health care in San Francisco

HSF is a safety net program that ensures all uninsured San Franciscans have access to medical care in San Francisco at an affordable cost

Services include:

• Preventive, Routine, Urgent and Specialty Care, Emergency Care, Alcohol and Drug Abuse Care, Laboratory Services and Tests, Mental Health Care, Prescription Medicine – ONLY WITHIN THE HSF NETWORK

Services do not include:

• Dental, Vision, Acupuncture, Chiropractic, Cosmetic, Infertility, Long-term care

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HSF isn’t insurance because it provides limited services in a limited network

• Participants choose one of 23 City & private clinics to be their medical home to get all their primary care

• Specialty care is provided by UCSF doctors working at SFGH

• Hospital care is limited to SFGH, even for emergencies

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Employees must individually apply to enroll in HSF

Employees assigned to HSF category must apply to enroll into HSF

•Employee makes an appointment to enroll

•Applications are needed to:

• Enroll employees and family members into government-sponsored health insurance wherever possible

• Determine the fee the employee must pay based on the household income

• Review documents relating to family income and assets

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HSF participants must pay quarterly participation fees

Fees for Healthy San Francisco are based on the employee’s household income

If you choose the City Option, your employee gets a 75% discount off the HSF participation fees (with $39 minimum employer contribution)

If an employee is at this percentage of the Federal

Poverty Level…

0 – 100%

101 – 200%

201 – 300%

301 – 400%

401 – 500%

501% +

Family of 1 annual income $10,210 $20,420 $30,630 $40,840 $51,050 $51,051+

Family of 4 annual income $20,650 $41,300 $61,950 $82,600 $103,250 $103,251+

The quarterly participant fee WITHOUT the discount is…

$0 $60 $150 $300 $450 $675

The quarterly participant fee WITH the discount is…

$0 $0 $0 $75 $113 $169

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HSF participants also pay for services

Point of service fees for primary care vary by clinic

Fees for specialty care, prescriptions, and hospital care:

Service 0 – 100% FPL 101 – 500% FPL 501% + FPL

Specialty $0 $20 $50

Pharmacy $0 $5/$25 $25/$50

Emergency Room $25 $50 $100

Same Day Surgery $0 $100 $200

Inpatient Hospital Stay $0 $200/admit $350/admit

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Employees may continue HSF participation even if they leave your employment

• Employees may continue to participate in HSF so long as they meet HSF criteria

• Even if employee resigns/is terminated

• Even if you choose another option to comply with HCSO

• In such cases, your employee loses the participation fee discount

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There are four steps for complying with HCSO using the City option

1. Register on the HSF website :healthysanfrancisco.org/employers

2. Enter (or upload a spreadsheet of) all employees on whose behalf you are making a payment

3. Print out the list of employees and mail it in with your check (paying electronically is coming soon)

4. Print out notice to employees and give it to employees for whom you sent money to City Option.

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Once we get your check, we will assign employees to HSF or to an MRA and notify them

We will send each employee a letter telling the employee what to do next

• Employees need the letter to access their MRA or apply for HSF

• Letter will take 2-4 weeks to get to your employee

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Maria case study

Maria lives in San Francisco, is uninsured, has two kids, gets $50/month into City Option. Household income is $45,000/year.

• Maria gets letter saying $$ into HSF for her, should apply

• Maria gets into HSF and pays nothing,each child gets insurance through Healthy Kids program at $108/year

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Peter – case study

Peter lives in Daly City, is uninsured, has two kids, gets $50/month into City Option

• Peter gets letter saying an MRA has been opened for him

• Peter has medical bill of $350 six months later

• Peter would get $276 (6 mos x $50 - $4) of his medical bill reimbursed

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Much more information is available on the website

For questions about City Option, Medical Reimbursement Accounts, Healthy San Francisco, go to:

www.healthysanfrancisco.org

For questions about complying with the HCSO ordinance generally, go to:

www.sfgov.org/olse/hcso

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Important things to remember

1. Health insurance is the best choice if you can manage it

2. If you choose the City Option, payments for employees who live in San Francisco will go to HSF and payments for other employees will go into an MRA

3. To use the City option, go to www.healthysanfrancisco.org

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Questions?