First Amendment to
                          Employment Agreement Between
                     Mid Atlantic Medical Services, Inc. and
                                 ▇▇▇▇▇▇ ▇. ▇▇▇▇
This  amendment  shall  be  the  First  Amendment  to the  Employment  Agreement
("Agreement") between Mid Atlantic Medical Services, Inc. ("Company") and ▇▇▇▇▇▇
▇. ▇▇▇▇ which was entered into as of January 8, 1999.
WHEREAS,  the Agreement  provided for a limited retirement benefit to be paid to
▇▇. ▇▇▇▇ in addition to other benefits; and
WHEREAS,  the  Company  believes it is in the best  interests  of the Company to
provide  additional  retirement  benefits to ▇▇. ▇▇▇▇ as well as adjust  certain
other benefits;
NOW THEREFORE, the parties agree to amend the Agreement as follows:
1.       Stock Options:  Add the following to Paragraph 4:
     "On both  January  1, 2000 and  January  1, 2001,  the  Company  will grant
     Executive  options to purchase no less than 130,000  shares of MAMSI common
     stock at the stock price on the date of grant.  Such  options will vest 50%
     on the date of grant and 50% based on  performance  to be determined by the
     Stock Option Committee and the Board at the first Board meeting in 2000 and
     2001 respectively."
2. Termination for Disability:  Replace "thirty (30)" in Paragraph 5 (a)(i) with
"ninety (90)".
3. Termination Under Change in Control:  Delete Paragraph 6 and replace with the
following:
     "6. Change in Control. Notwithstanding any other provision to the contrary,
     the following provisions will govern in the event of a change in control as
     defined herein.
a.       A change in control  shall be deemed to have  occurred if, at any time,
         (i) substantially all the assets of the Company shall have been sold or
         transferred by sale,  merger or otherwise,  or if any "person" (as such
         term is used in Sections 13(d) or 14(d) of the Exchange Act) is or (ii)
         becomes the beneficial owner, directly or indirectly,  of securities of
         the Company  representing  50% or more of the combined  voting power of
         the then-existing outstanding securities of the Company.
b.       In the event of a change in control as defined in Section  6(a)  above,
         Executive  shall be entitled to a lump sum payment which shall be equal
         to two times the Executive's Base Salary and two times the amount equal
         to the  maximum  bonus  the  Executive  could  have  earned  under  the
         applicable  bonus  plan for the year in which  such  change in  control
         occurs in lieu of  payment  under the bonus  plan.  Upon  payment,  the
         obligations  of the Company to employ  Executive  under this  Agreement
         shall cease.
c.       In the event of a change in control as defined in Section  6(a)  above,
         all stock options to which Executive has been granted shall immediately
         vest and become exercisable.  Such acceleration of the vesting of stock
         options  shall be in  addition  to,  and shall  have no affect  on, any
         payments accrued pursuant to subsection 6(b).
d.       In the event of a change in control as defined in Section  6(a)  above,
         the Company  shall also pay to  Executive an amount equal to the sum of
         (x) excise taxes  imposed on the  Executive  under  Section 4999 of the
         Internal  Revenue Code and (y) income taxes due from the Executive with
         respect to the payment of the amount in subsection (x) above as well as
         the payment for income taxes under this subsection 6(d).
e.       In the event of a change in control as defined in Section  6(a)  above,
         or any  successor  changes in control  thereafter,  the  payment of all
         retirement  benefits as defined in Section 5(d) of this Agreement shall
         become the obligation and  responsibility  of the successor  company or
         "person" noted in Section 6(a) above."
4. Retirement: Delete Paragraph 5(d) and replace it with the following:
     "(d)  Retirement.   Subject  to  the  vesting  schedule  set  forth  below,
     retirement  benefits  shall be payable to  Executive  beginning  on the day
     Executive  attains  age  sixty-two  (62),  (1) if he is at that time  still
     employed by the Company,  and he elects to retire from  employment with the
     Company,  or (2) he is not at the time employed by the Company,  and elects
     to  begin  receiving   retirement   benefits.   Notwithstanding  the  above
     provision,  the  Executive and the Company may agree that the Executive may
     continue  to be  employed  by the  Company  and not to retire at age 62. In
     addition,  the  Executive  may elect an early  retirement  and may elect to
     receive payment of the retirement benefit at anytime after attaining age 55
     but before age 62 by providing  written  notice to the Company.  Such early
     retirement   benefit  will  be  actuarially   adjusted  solely  for  actual
     retirement age and will be subject to the vesting schedule  provided below.
     The  date on which  the  Executive  retires  shall  be  referred  to as the
     "Retirement Termination Date".
     If  Executive  retires  on or  after  reaching  age 62,  Executive  will be
     entitled  to  receive  from the  Company a  retirement  benefit  which will
     provide an annual  lifetime  benefit in an amount equal to three percent of
     the total average annual Base Salary and bonus  compensation  for the years
     beginning  on or after  January 1, 1999 times the total number of months of
     service  with the Company,  including  all months prior to January 1, 1999,
     divided by 12 to a limit of 60% of Executive's total  compensation  defined
     as the  total  amount  of annual  salary  and  maximum  annual  bonus  that
     Executive could have earned in the calendar year of Executive's termination
     of employment with the Company.  If Executive  elects early  retirement and
     retires after  reaching age 55 but before age 62, the annual  payment shall
     be adjusted so that the total amount of  retirement  benefits to be paid do
     not exceed the  actuarial  equivalent  of the amount  which would then have
     been payable in retirement  benefits had  Executive  reached and retired at
     age  62.  For  the  purposes  of  determining  actuarial  equivalency,  the
     retirement  benefit  will be  reduced by .25% per month for each month that
     the actual retirement age is below age 62.
     Retirement  benefits  will vest 50% if Executive is employed by the Company
     on January 1, 2000 and the  remaining  50% if the  Executive is employed on
     January 1, 2001 and 100%  immediately  upon a change in  control,  death or
     disability. Such retirement benefit shall be paid in single annual payments
     for  the  life  of the  Executive  with  the  initial  payment  made to the
     Executive on the  Retirement  Termination  Date.  The Company  shall not be
     obligated  to pay any  retirement  benefit  under  this  subsection  if the
     Executive is terminated for cause by the Company.
     Executive  may elect a beneficiary  to receive a survivor  benefit upon the
     Retirement  Termination Date. If Executive dies prior to retirement without
     naming a beneficiary,  then Executive's surviving spouse shall be deemed to
     be his named  beneficiary or if Executive has no surviving  spouse,  to his
     issue per stirpes.  If Executive dies prior to retirement,  the Executive's
     named  beneficiary  shall be entitled to elect a lump sum benefit,  payable
     immediately or in annual payments over the beneficiary's  lifetime,  of the
     actuarial equivalent of the retirement benefit earned to the date of death.
     For this  purpose,  the Company  will use the lower of the U.S.  Government
     T-▇▇▇▇ Rate or 5% and a  mortality  table in general use at the time of the
     Executive's death.
     If Executive is employed by the Company on the Retirement Termination Date,
     the Company  shall pay to Executive  his Base Salary as then in effect that
     has  accrued  to  the  last  day of  the  month  in  which  the  Retirement
     Termination Date occurs and any non-reimbursed business expenses."
5.       Business Automobile:  Add the following new paragraph:
     "10.  Business  Automobile.  The  Company  shall  pay  to  Executive  a car
     allowance of $450 monthly."
6.       Health Insurance:  Add the following new paragraph:
     "11. Health  Insurance.  Both the Executive and the spouse of the Executive
     at the time of  retirement  or spouse upon death of the  Executive  will be
     eligible for health  coverage from the Company or its successor  during the
     term of their  respective  lives.  Such  health  coverage to be paid for by
     Executive  or  the  spouse  of  the  Executive   with  the  normal  Company
     contribution for active employees in effect during the period of coverage."
7. Covenant Not to Compete: Add the following new paragraph:
     "12.  Covenant Not to Compete.  Executive  covenants  and agrees  that,  in
     consideration of the amounts to be paid Executive  hereunder and other good
     and valuable consideration, for a period of one (1) year beyond the Without
     Cause  Termination  Date,  Executive  shall not be employed as an executive
     officer of, control,  manage, or otherwise participate in the management of
     the  business  of a  "significant  competitor"  of the  Company.  The  term
     "significant  competitor"  shall mean any  company or division of a company
     that, on Effective Date, directly or indirectly, is materially (10% or more
     of its  revenues)  engaged  in the  operation  or  management  of a  health
     maintenance  organization or any other similar  provider,  payer or insurer
     for medical  services.  The Company and Executive  agree that the terms and
     conditions  of this  Section  12  shall  survive  the  termination  of this
     Agreement following the Termination Date."
8. All other terms and conditions of the Agreement  remain unchanged and in full
force and effect.
9. This Amendment shall be effective as of August 11, 1999.
Signed and delivered this ____ day of September,  1999 in the Company's  offices
at ▇ ▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇.
By:  Mid Atlantic Medical Services, Inc.        By:  ▇▇▇▇▇▇ ▇. ▇▇▇▇
▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇                                ▇▇▇▇▇▇ ▇. ▇▇▇▇
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Name                                                           Name
President and CEO                               Senior EVP and CFO
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Title                                                         Title