Have you noticed that some restaurants have an extra line at the bottom of the bill? It usually reads “ Healthy San Francisco Surcharge”. This extra charge allows restaurateurs to pay for the city ‘s health care program and they vary depending on the restaurant (however, it’s usually around 4%). San Francisco took the first steps towards achieving universal health care in the city by implementing the Health Care Security Ordinance in January 2008.

What is it?

This ordinance implemented a pay-or-play employer health-spending mandate. It requires those firms employing 20 or more employees to contribute a minimum amount to health benefits per employee-hour. There are three options for restaurants: to provide private insurance, pay into a reimbursement account or contribute to Healthy San Francisco.


 It’s a low-cost access plan created to cover primary specialty care, urgent and emergency care, laboratory tests inpatient hospitalization, radiology and pharmaceuticals. The plan provided a “public option” as an alternative to private health insurance for employers to choose to satisfy the mandate.

Mandated Contribution

During 2008 in San Francisco, the mandated contribution was $1.76 per worker per hour or $3,632 per year, for each full-time worker for those companies with a hundred or more employees. Those companies with 20 to 99 employees, they were required to contribute at least $1.17 per worker-hour.

Am I required to include SF Health on my restaurant bill?

No, the city of San Francisco does not impose any restaurant to include SF Health on their bills. It remains at the discretion of any business to decide whether to impose a health care surcharge or not.

Can a customer refuse to pay SF Health?

There’s obviously a huge debate when it comes to tipping or not tipping or if a customer should pay for a mandatory “gratuity” when they get the bill. There is not a correct answer and laws are different depending on the state the restaurant is located.

However, all laws agree on the fact that if the information is clearly stated on the menu and well explained, the customer will have to pay that “gratuity”. Nobody is forcing a customer to enter a restaurant. Furthermore, they have the information available on the menu before even entering the restaurant. Therefore, if they do not agree, they can just leave. But if they do enter, they are consequently accepting the restaurant policy.

Thinking of starting a restaurant in San Francisco

Piedmont Avenue Consulting, Inc. works with many restaurants in the Bay Area and beyond with creating and implementing operation systems and marketing strategies. Call at 510-761-5895 to schedule a free consultation with the CEO and Founder, David Mitroff, and we’ll help you go through processes such as understanding the Health Care Security Ordinance.