The HCSO Ordinance applies to businesses in San Francisco with 20 or more employees. To be eligible, an employee has to work more than 8 hours a week. There is a 90 days of employment period for an employee to qualify and begin to accrue funding. For 2018, the new rate is $1.89 for every hour worked. The number of hours is capped at 516 hours per quarter; a maximum deposit of $975.24 in a given quarter.

These costs can be sent to HCSO, which will establish an account for the participant. Contributions must be sent to HCSO by the end of each month. Your employees can use these funds at a City Clinic or can be reimbursed for the cost of care or insurance premiums they pay on their own by submitting a form to HCSO.

There is one option that gives you, the employer, more control of these required benefits as to the money and coverage, and that is to establish a Health Reimbursement Plan – HRP. You will still have the eligibility and $1.89 per hour, but you maintain the money in an “escrow” account within your business. As a Third Party Administrator, TPA, we provide the documents, communications, claims paying authority and quarterly reports to your covered employees. We are a Fiduciary as you are as well.

As with other businesses, there is a turn over and employees leave. At that time, they should be given an accounting of their benefits and a three month window to claim any amount for claims for medical/dental expenses that they had incurred while employed with you. You should then hold the balance of their account for 6 month to a year. If they do not claim the money or come back to work for you, the account reverts back to you. It is not transferable to another employer.

As a TPA, we have a set-up fee and an annual renewal fee. We are retained for a year. We would like any census and deposit report in an Excel form. We will provide a quarterly report for each employee or to the day of termination. All claims have to be submitted to us on our claim form along with receipts or statements from medical/dental professionals. We will supply an approved list of all coverages.

If you have a management team as salary employee or a management company LLC, you can have a separate Health Reimbursement Plan more tailored to fit your personal situation. We also do all benefits as well as 401(k)’s and personal financial planning. As a fiduciary, all fees and costs are discussed in advance of any investments.

Should you have questions or concerns about your current plans or would like to discuss your options, please contact us directly.