Where 99.99% is used
Enterprise commitments, payment infrastructure, and the availability tier cloud providers publish for their own managed services. Rarely offered by small teams, and rarely achieved by teams that offer it.
What it demands
Redundancy at every layer with no manual step in the recovery path. At this tier a human cannot be in the loop: by the time a person reads the alert, the monthly budget is spent. Deploys have to be safe by construction, because a bad release is a breach.
One step either way
Dropping to 99.95% widens the monthly budget to 21m 36s. Moving up to 99.999% cuts it to 26s.
Measuring it
You cannot report on a service level you are not measuring at a finer resolution than the budget itself. At 99.99% the monthly allowance is 4m 19s, so a check interval anywhere near that figure will miss breaches entirely. Work out your own numbers, or monitor it continuously from four regions, free to start.