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DocuSign Envelope ID: 10DC72A2-A9C6-40FB-A2DC-2AB28AF423E9 <br />EXHIBIT A-1 to Third Amendment <br />® 2020 <br />N 2021 <br />❑ Client does not have the Grace period Provision and is opting not to add the carryover or extended <br />grace period feature at this time. <br />4. Client agrees to wait for guidance and before adding spend down to the Health FSA. No Additional amendment <br />fees will apply if this change is adopted in response to guidance prior to December 31, 2021. <br />❑ Please put client on the interest list and reach out once guidance is available. <br />N Client is not interested I this option <br />S. N Add Spend Down to my DCAs (please check this box if you are not sure if your plan includes this provision and <br />want to make sure it has been added). Please also select whether you wish to make this change retroactive to <br />the plan year that ended in 2020: <br />❑ No <br />6. Optional: Add/or Extend Mid -Year Election Changes Without Requiring a Qualifying Event as listed below. These <br />provisions are prospective for new adopters or will be extended to the end of the plan year ending in 2021 for <br />employers that adopted this provision under the CARES Act. <br />➢ Health FSA: revoke an election <br />➢ Health FSA: make anew election <br />➢ Health FSA: increase/decrease an election NOTE: If an employee makes a new Health FSA <br />election, they will not be able to contribute to an HSA (if applicable) <br />➢ DCA: revoke an election <br />➢ DCA: make a new election <br />➢ DCA: increase/decrease an election <br />N Add prospectively <br />❑ Extend <br />❑ Client did not adopt this provision and wishes not to at this time. <br />Plan Design Change CAA 2021 COVID-19 —SOW: Page 3 <br />C/LUF' <br />© Igoe Administrative Services <br />