Common use of Coverage Level Election Clause in Contracts

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 2019, to 12:00 a.m., Eastern Time, May 31, 2020, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192020, to 12:00 a.m., Eastern Time, May 31, 20202021, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 201920192020, to 12:00 a.m., Eastern Time, May 31, 202020202021, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192020, to 12:00 a.m., Eastern Time, May 31, 20202021, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%):

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 201920202021, to 12:00 a.m., Eastern Time, May 31, 202020212022, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 201920242025, to 12:00 a.m., Eastern Time, May 31, 202020252026, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192025, to 12:00 a.m., Eastern Time, May 31, 20202026, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 201920212022, to 12:00 a.m., Eastern Time, May 31, 202020222023, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 2019, to 12:00 a.m., Eastern Time, May 31, 2020, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%):

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192024, to 12:00 a.m., Eastern Time, May 31, 20202025, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 201920222023, to 12:00 a.m., Eastern Time, May 31, 202020232024, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%):

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 201920232024, to 12:00 a.m., Eastern Time, May 31, 202020242025, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%):

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192023, to 12:00 a.m., Eastern Time, May 31, 20202024, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192021, to 12:00 a.m., Eastern Time, May 31, 20202022, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192024, to 12:00 a.m., Eastern Time, May 31, 20202025, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192021, to 12:00 a.m., Eastern Time, May 31, 20202022, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%):

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192025, to 12:00 a.m., Eastern Time, May 31, 20202026, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%):

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192025, to 12:00 a.m., Eastern Time, May 31, 20202026, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90% (2) Additional Living Expense (ALE) Written as Time Element Coverage Yes – Time Element ALE No – Time Element ALE

Coverage Level Election. The Company hereby elects the following Coverage Level for the Contract Year from 12:00:01 a.m., Eastern Time, June 1, 20192022, to 12:00 a.m., Eastern Time, May 31, 20202023, (the individual executing this Contract on behalf of the Company shall place his or her initials in the box to the left of the percentage elected for the Company): 45% OR 75% OR 90%