City & County of SF Employees

The City and County of San Francisco offers eligible employees the opportunity to enroll themselves and eligible family members in medical, dental, vision and Flexible Spending Account (FSA) benefits. Enrollment must take place within 30 days of the start work date, no later than 30 days after a qualifying event, or during the annual Open Enrollment period, which takes place each year during the month of October.

If you have a Qualifying Life Event outside of the Open Enrollment period, you can make your Life Events updates online through the Employee Portal. Visit our Qualifying Life Event page for more information.

The following are eligible to participate in the San Francisco Health Service System (SFHSS) as members:

• All permanent employees of the City and County of San Francisco whose normal work week is not less than 20 hours.
• All regularly scheduled provisional employees of the City and County of San Francisco whose normal work week is not less than 20 hours.
• All other employees of the City and County of San Francisco, including temporary exempt “as needed” employees, who have worked more than 1,040 hours in any consecutive 12 month period and whose normal work week is not less than 20 hours.
• Elected Officials.
• All members of designated boards and commissions during their time in service to the City and County of San Francisco as defined in San Francisco Administrative Code Section 16.700(c).
• All officers and employees as determined eligible by the governing bodies of the San Francisco Transportation Authority, San Francisco Parking Authority, and Treasure Island Development Authority, Superior Court of San Francisco and any other employees as determined eligible by ordinance.
• All other employees who are deemed 'full-time employees' under the federal Patient Protection and Affordable Care Act (section 498OH).

SFHSS offers a variety of medical plan options to allow you to select the plan that provides the right coverage at the right cost for you and your covered family members to remain healthy and productive. SFHSS offers four Health Maintenance Organization (HMO) plans and one Preferred Provider Organization (PPO) plan.

Health Maintenance Organization (HMO)

An HMO is a medical plan that offers benefits through a network of participating physicians, hospitals and other healthcare providers working closely together to help coordinate your care. You select a Primary Care Physician (PCP) who will coordinate all non-emergency care and services including access to certain specialists, programs and treatments that are in the same medical group or network. You must live or work in a ZIP code serviced by the plan to enroll. Under these plans, there is no plan year deductible before accessing your benefits. Most services are available for a fixed

Preferred Provider Organization (PPO)

A PPO is a medical plan that provides access to a network of health care providers (doctors, hospitals, labs, pharmacies, etc.) known as preferred providers. You pay less when you to seek services from preferred providers. However, the plan allows you the option of seeing non-preferred providers, but requires you to pay a higher percentage of the bill. Generally, when compared to HMO medical plans, PPOs usually result in higher out-of-pocket costs and a deductible will apply to many services. Instead of having a fixed co-pay for medical services, your cost share may vary as a percentage of what the provider charges, known as a “coinsurance”. You will need to pay your plan year deductible prior to paying your coinsurance for the applicable service.

City and County of San Francisco employees can choose from Health Net CanopyCare HMO, Blue Shield of California Access+ HMO, Blue Shield of California Trio HMO, Kaiser Permanente HMO or Blue Shield of California PPO health plans.

Please note that Health Net CanopyCare HMO, Blue Shield of California HMO and Kaiser Permanente HMO require enrollees to live or work in a zip code serviced by their plan. Blue Shield of California PPO does not have service area requirements.

SFHSS offers three dental plan options for our members to choose from. Two are Dental Health Maintenance Organization (DHMO) plans and one is a Dental Preferred Provider Organization (DPPO) plan.

DHMO Dental Plans

Similar to medical HMOs, Dental Health Maintenance Organization (DHMO) plans require you to receive all of your dental care from their network of participating dental providers. These networks are smaller than dental PPO networks. Before you elect a DHMO plan, make sure the plan’s network includes your chosen dentist, and that dentist is accepting new patients. Under DHMO plans, services are covered either at no cost or with a fixed co-pay. Out-of-pocket costs for these plans are generally lower than PPO plans. SFHSS offers the following DHMO dental plans: ƒ

• DeltaCare USA DHMO ƒ
• UnitedHealthcare Dental DHMO

PPO Dental Plan

A PPO dental plan allows you the flexibility to visit any in-network or out-of-network dentist. The plan covers a higher percentage of the costs for covered services when you go to an in-network PPO dentist. Out-of-network providers may bill you for the difference between your co-insurance and Delta Dental's reimbursement, which is based on a coverage limit for the service.

Delta Dental PPO Plus Premier

Delta Dental PPO Plus Premier has two different networks. Ask your dentist if they participate in the Delta Dental PPO or Premier network. You will pay a higher coinsurance when you visit a Premier provider versus a PPO provider. When you use Delta Dental's network dentists, you are only responsible for the deductible and co-insurance, within applicable benefit maximums. Delta Dental's network dentists are not allowed to charge you more for covered services beyond the negotiated rates. You may also visit an out-of-network dentist. Out-of-network providers may bill you for the difference between your co-insurance and Delta Dental's reimbursement, which is based on a coverage limit for the service. This is known as a balance billing.

SFHSS recognizes that dental benefits are a very important part of your healthcare coverage and for maintaining your good overall health. Consequently, City & County of San Francisco employees have three dental plans to choose from: Delta Dental PPO, DeltaCare USA DHMO or UnitedHealthcare Dental DHMO. 

PPO-style dental plans, like Delta Dental PPO, allow you to visit any in-network or out-of-network dentist. DHMO (short for Dental Health Maintenance Organization) plans require you to receive all your dental care from within a network of participating doctors.

All SFHSS members and their dependents who are enrolled in an SFHSS medical plan are automatically enrolled in the VSP Basic Plan at no additional cost. We also offer an enhanced plan called the VSP Premier Plan at an additional cost based on the number of members enrolled in coverage.

If you do not enroll in a medical plan, you and your dependents cannot access VSP Vision Care benefits.

SFHSS understands that there are more areas in your life that need additional services, care or coverage. To meet your expanding needs, we offer a large spectrum of additional benefits designed to complement, protect and enhance your quality of life and financial security for your family due to unforeseen events. 

Additional benefits range from Life and Disability insurance, which comes with different union memberships, Flexible Spending Accounts (FSAs), which allow you to spend pre-tax dollars on health expenses and/or child or elder care, the Employee Assistance Program (EAP), which provides counseling and other mental health services to employees, and a Surrogacy and Adoption Assistance Plan.

Voluntary Benefits offer a variety of competitive, group-priced plans and services designed to help protect you and your family in the form of additional insurance coverage and consumer protection services that can help relieve some of the financial pressures brought on by unexpected events.

SFHSS has partnered with WORKTERRA to offer quality insurance plans at the best cost.

• San Francisco Health Service System reviewed and approved
• For new hires, guaranteed issue - no medical history or exam required
• Discounted group premium rates
• Optional enrollment - if you choose to enroll, premiums can be paid by payroll deduction

Go to Voluntary Benefits for a complete list of plans and services.