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San Francisco City Option

info@sfcityoption.org

1 (877) 772 - 0415

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SF MRA Enrollment Form

Complete this form to determine if you qualify for a Medical Reimbursement Account (SF MRA). After you submit this form, SF City Option (SFCO) will let you know if you are eligible for SF MRA within 1-3 weeks.

If you have any questions, please call Customer Service at 1(877) 772-0415 Monday through Friday, 8:30am-5:30pm Pacific Time or email info@sfcityoption.org.

Required Fields


Date of Birth


Social Security Number *

We only use the provided information, including your SSN, to match your enrollment to employer contributions. 

  • The SFCO Program is committed to protecting the privacy of your personal information. SF City Option will not share your personal information with any outside agencies, including law enforcement.
  • Your immigration status will not affect your eligibility for the SF MRA Program.

If you have any questions or concerns, please call SF City Option Customer Service at 1 (877) 772-0415 or email info@sfcityoption.org. 



By providing your phone number and/or email address you agree to receive emails or calls from the SFCO program. If you want to stop receiving SFCO calls and/or emails, please call Customer Service at 1 (877) 772-0415 or email info@sfcityoption.org.  

Preferred Method of Contact



Certification *