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FORMS

Superior Court Health Insurance Forms

PLAN MEMBERSHIP

There are four plans in which General members are enrolled: Plan 2, Plan 5, Plan 7 and Plan 8.

Plan Assignment

Membership Date

Bargaining Unit

General Plan 2

Jul 1, 1986 through Jan 10, 1999

By Member Election

General Plan 5A

Before Oct 10, 1994

Not Applicable

General Plan 5B

On or After Oct 10, 1994

10, 11, 14, 15, 17, 20, 35, 36, 40, 41, 42 or 43.

General Plan 5C

On or After Oct 10, 1994 and Before June 24, 2012

21, 22, 23, 24, 25, 26, 27, 28, 29 or 32.

General Plan 7

On or After June 25, 2012 and Before Jan 1, 2013

21, 22, 23, 24, 25, 26, 27, 28, 29 or 32.

General Plan 8

On or After Jan 1, 2013

Not Applicable

APCD members are classified as General Members. There are three plans in which APCD members are enrolled: APCD Plan 1, APCD Plan 2, and General Plan 5.

Plan Assignment

Membership Description

APCD Plan 1

If you became a member on or after July 3, 1995

APCD Plan 2

If you became a member before January 1, 1981

There are three plans in which Safety members are enrolled: Safety Plan 4 (for Fire and Probation employees), and Safety Plan 6 (for Sheriff and District Attorney Investigator (DAI) employees). Within each plan there are tiers (designated by A, B, or C) based on your membership date and/or bargaining unit:

Plan Assignment

Membership Description

Safety Plan 4A

Fire employees who became members prior to 10/10/94 (& all Carp/Summerland Fire employees regardless of membership date)

Safety Plan 4B

Employees in Probation management/executive classifications or in the classification of Fire Chief who became members on or after 10/10/94

Safety Plan 4C

All Probation employees represented by the Probation Peace Officers Association (regardless of membership date), and Fire employees who became members on or after 10/10/94 (except Fire Chief)

Safety Plan 6A

Sheriff/DAI employees who became members prior to 10/10/94

Safety Plan 6B

Sheriff/DAI employees who became members on or after 10/10/94

Safety Plan 8

All Safety members hired on or after 1/1/2013; Single Rate