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Plan Eligibility

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Groups

Any employer meeting both of the following qualifications is eligible:

1. the company has 1 or more employees working in San Francisco who are subject to the Health Care Security Ordinance; and
2. the company has 51¹ or more employees in total (regardless of whether they work in San Francisco or elsewhere) employed under the same Federal Employer Identification Number.

There are no excluded industries.

Coverage under this plan will apply only to the employees who work within the geographic boundaries of the City and County of San Francisco and who are subject to the Health Care Security Ordinance.

All eligible employees subject to the Ordinance must be covered by the plan and the employer must pay the entire premium.

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Employees

All employees who are in Active Service² working an average of 8 or more hours³ per week in San Francisco and who have completed 90 days of employment with the employer are eligible.

The only exception is employees who have coverage through another employer (either as an employee or a dependent) may voluntarily decline coverage. Coverage under an individual policy does not qualify. A special “Waiver” form, signed by the employee, is required by the City from any employee who is subject to the Health Care Security Ordinance and for whom the employer is not making the required contributions.

Note:

The Health Care Security Ordinance applies only to employees who are subject to the Minimum Wage Ordinance (Chapter 12R of the San Francisco Administrative Code). Contributions, therefore, are not required for owners of a business.

There are no health questions or other qualification requirements.

Coverage is not available for dependents.

The benefits for which an employee is insured are determined by the class (determined by average hours worked) to which he or she is assigned by the employer:

• Class One – Part-time employees averaging 8 to 19 hours per week
• Class Two – Part-time employees averaging 20 to 39 hours per week⁴
• Class Three – Full-time employees averaging 40 or more hours per week⁴

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¹The San Francisco Health Care Security Ordinance applies to all employers with 20 or more employees. Because of conflicting California small group insurance law, however, this plan cannot be sold to employers with 50 or fewer employees.

² "Active Service" means that the employee is actively at work performing all regular duties at his/her employer's place of business or someplace the employer required him/her to be.

³ The Ordinance stipulates that average hours worked per week is to be measured over the previous 90 days. 

⁴ Because of ACA requirements on full-time employees, we suggest that only part-time employees working less than 30 hours per week be enrolled in the AGU San Francisco Limited Accident & Sickness Indemnity Plan.