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, 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, 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, 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, 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, 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, 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, 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, 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%

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, 20192026, to 12:00 a.m., Eastern Time, May 31, 20202027, (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%31 FHCF-2026K Rev. 11/25 Rule 19-8.010 F.A.C. Docusign Envelope ID: 23AFA1AA-4735-47A5-BD91-749CDBF5493E

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, 20192026, to 12:00 a.m., Eastern Time, May 31, 20202027, (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%31 FHCF-2026K Rev. 11/25 Rule 19-8.010 F.A.C. Docusign Envelope ID: B8764681-2A69-4D48-93E5-8D3286D1B6CB

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, 20192026, to 12:00 a.m., Eastern Time, May 31, 20202027, (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%31 FHCF-2026K Rev. 11/25 Rule 19-8.010 F.A.C. Docusign Envelope ID: 21AEC3FD-0D63-4A72-B33D-C0ABE836FC99

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, 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%):