Exhibit_B_Spouse_Life_Age_Reduction_Amendment_1.1.26.pdf

Standard Online Amendment Request 1 of 1 12/1/2025 2:26 PM

Request for Group Insurance Amendment

Standard Insurance Company 900 SW Fifth Avenue Portland, OR 97204-1282

Employee Benefits Consultant: Adam Kole Employee Benefits Service Representative: Christine D'Angelo Employee Benefits Sales and Service Office: Tampa

Policyholder: Brevard County Board of County Commissioners Group Number: 641728

As an authorized representative of the Employer, I request that Standard Insurance Company (“The Standard”) amend the above Employer’s coverage under the Group Policy to make the following change(s):

Change Age Reductions for Spouse to be based on Member's age instead of Spouse's age.

I request that the amendment become effective on 01/01/2026. I understand that the amendment will not become effective unless approved and issued by The Standard.

I request that the amendment be approved by The Standard subject to The Standard’s usual underwriting requirements, including, if applicable, Evidence of Insurability or a Pre-existing Condition provision.

I understand that the amendment, if approved by The Standard, will be issued in the policy language customarily used by The Standard.

I understand that any increase in Insurance for a Member who is not Actively At Work all day on the Member’s last regular work day before the scheduled effective date of the amendment will be deferred until the first day after the Member completes one full day of Active Work.

I request that the amendment, if approved and issued by The Standard, become effective by its terms without any further acceptance by the Employer, and that a copy of this Request for Group Insurance Amendment form be attached to and made a part of the amendment.

Sign Name: Title: \s1\ \t1\ Authorized Representative

Print Name: Date: \n1\ \d1\