HCSO HRA Employee Resources

Check your account balance

How to File a Claim

The Health Care Security Ordinance (HCSO) is a San Francisco law that created an Employer Spending Requirement enforced by the Office of Labor Standards Enforcements. The Employer Spending Requirement requires Covered Employers to spend a minimum amount of money on Health Care Expenditures for their Covered Employees. Your employer is satisfying the HCSO requirement by supplying you with a HCSO Health Reimbursement Arrangement (HRA). For more information on your HCSO HRA, please see the Summary Plan Description.

HCSO GUIDELINES FOR SUBMISSION OF CLAIMS: The IRS provides the following guidance:

Medical Reimbursement

When receipts are submitted to BeneFLEX, they must show the following information:

  1. Who rendered the service (name and address)
  2. What type of service rendered
  3. Date service was provided, not a billing or due date
  4. Amount of charge

NOTE: In order to process your claim all 4 pieces of information must be on each receipt. This includes receipts for orthodontic services.

  • Canceled checks and credit card slips are not allowable receipts.
  • Any amount claimed which is a ‘Previous Balance’, ‘Balance Forward’, etc. cannot be paid unless the information stated in items 1-4 above is shown on the receipt.
  • Receipts must show all expenses incurred. Any over-payment, pre-payment, etc., for which no services are listed, cannot be reimbursed.
  • BeneFLEX cannot reimburse for any medical expenses incurred before activation in the HCSO HRA plan.
  • Over the Counter (OTC) drugs – Partial listing online at beneflexhr.com
    • When and Who Sold the product (date, name and address)?
    • Type of OTC purchased. *Must show product or brand name
    • Amount of charge

* If the receipt does not show the name of the product, you can write the product name on the receipt. You must have the cashier verify by signing their name.


  • To ensure timely reimbursement, all claims must be faxed to (314) 909-6983 or mailed to 10805 Sunset Office Drive, Suite 401 St. Louis, MO 63127 and received no later than 1:00 p.m. (PST) Tuesday for Thursday processing.
  • If you fax your claim, keep a copy of the confirmation statement in case BeneFLEX does not receive your paperwork.
  • If you terminate employment, check your SPD to see the Grace Period and run-out period you have available to use and file claims for your HCSO funds.
  • Please itemize the expenses on your claim form.
  • You can contact BeneFLEX HR Resources, Inc. by e-mail at info@beneflexhr.com or by calling (800) 631-3539 for questions regarding your plan.


HCSO  HRA – English

HCSO HRA Employee Overview

HCSO HRA Full Medical Spend Down Eligible Expense List

Dental/Vision/LTC Eligible Expense List

How to File a Claim

HCSO HRA Claim Form

HCSO HRA Direct Depostit Form

HRA Employee Waiver Form


HCSO  HRA – Spanish

HCSO HRA Employee Overview -Spanish

Dental/Vision/LTC Eligible Expense List – Spanish

HCSO HRA Full Medical Spend Down Eligible Expense List – Spanish

HCSO HRA Claim Form – Spanish

HCSO HRA Direct Deposit Form – Spanish

HRA Employee Waiver Form – Spanish