Resolution:

No. 13-01

Approving and Adopting Minimum Standards For Health Plan Benefits Required In the Healthcare Accountability Ordinance

WHEREAS, the Board of Supervisors passed the Healthcare Accountability Ordinance on May 29, 2001, requiring that contractors of the City and County of San Francisco (City) and lessees of City property, as well as certain subcontractors and subtenants, offer healthcare insurance to their employees; and,

WHEREAS, the Ordinance provides the Health Commission with the authority and responsibility to determine minimum standards for health plan benefits offered by City contractors and lessees; as well as certain subcontractors and subtenants; and,

WHEREAS, the components of the minimum standards for health plan benefits include:

1. effective date of coverage;
2. percentage of premium paid by employer and employee; 
3. benefits offered under coverage; and 
4. employee co-payments for accessing services; and,

WHEREAS, in developing the minimum standards, the Department of Health staff researched insurance plans in the California and Bay Area marketplace; and,

WHEREAS, the Department adopted the following principles in developing the minimum standards for health plan benefits:

• Minimal disruption for employers and lessors who currently provide a comprehensive scope of medical benefits,
• Reasonable out-of-pocket costs (both premiums and co-payments) for employees in order to maximize employees’ acceptance of health plan coverage, and,
• The minimum benefit standards designed to ensure that contractors and lessees provide a comprehensive scope of medical benefits; and,

WHEREAS, the Department will evaluate the minimum standards annually and report the results to the Health Commission on an annual basis; and,

WHEREAS, the Health Commission held public hearings on June 5 and June 19, 2001, accepted written public comments concerning the minimum standards, and considered carefully the input from the public; now, therefore, be it

RESOLVED, that the effective date of coverage be no later than 30 days following the start of employment by the employee on a covered contract, subcontract, lease, or sublease; and, be it

FURTHER RESOLVED, that employers offer at least one health plan option in which the premium is entirely paid for by the employer; and, be it

FURTHER RESOLVED, that health plan benefits include the following services:

• Professional Services
• Outpatient Surgery and Procedures
• Diagnostic, X-Ray and Laboratory Services
• Perinatal/Maternity
• Preventive Care
• Family Planning Services
• Prescription Drug Coverage
• Hospital Services (inpatient and outpatient)
• Emergency Services
• Ambulance Services
• Mental Health (inpatient and outpatient)
• Alcohol and Substance Abuse Care (inpatient and outpatient)
• Rehabilitative Therapies (inpatient and outpatient)
• Home Health Services
• Durable Medical Equipment
• Hospice Care
• Skilled Nursing Services;

and, be it

FURTHER RESOLVED, that the maximum employee co-payment for the following services shall be:

and, be it

FURTHER RESOLVED, that contractors, subcontractors, lessees, and subtenants that provide comprehensive health plan benefits to their employees, but who do not comply with the above co-payment schedule, have up to one year to comply with all components of the minimum standards; and, be it

FURTHER RESOLVED, that employers strive to offer at least one health plan option that includes culturally competent providers in its network; and, be it

FURTHER RESOLVED, that the Health Commission directs the Director of Health to evaluate the minimum standards annually and report the results to the Health Commission on an annual basis.

I hereby certify that the Health Commission at its meeting of June 19, 2001, adopted the foregoing resolution.

Arthur R. Greenberg, Interim Health Commission Secretary