AMENDED AND RESTATED MID ATLANTIC MEDICAL SERVICES, INC.
                        STOCK COMPENSATION TRUST AGREEMENT
              THIS AMENDED AND RESTATED STOCK COMPENSATION TRUST AGREEMENT
     made and entered into as of the 20th day of December, 1996, effective as
     of August 26, 1996, by and between Mid Atlantic Medical Services, Inc.,
     a corporation organized under the laws of the State of Delaware
     (hereinafter referred to as the "Company") and THE BANK OF NEW YORK, a
     New York banking corporation (hereinafter referred to as the "Trustee").
              WHEREAS, the Company (as defined below) desires to establish a
     trust (the "Trust") in accordance with the laws of the State of New York
     and for the purposes stated in this Agreement;
              WHEREAS, the Trustee desires to act as trustee of the Trust,
     and to hold legal title to the assets of the Trusts, in trust, for the
     purposes hereinafter stated and in accordance with the terms hereof;
              WHEREAS, the Company or its subsidiaries have previously
     adopted the Plans (as defined below);
              WHEREAS, the Company desires to provide assurance of the
     availability of the shares of its common stock necessary to satisfy
     certain of its obligations or those of its subsidiaries under the Plans
     (as defined below);
              WHEREAS, the Trustee has accepted such appointment as of August
     26, 1996;
              WHEREAS, the Company intends, that the assets of the Trust Fund
     shall be and remain subject to the claims of the Company's creditors as
     herein provided and that the Plans not be deemed funded by virtue of the
     existence of this Trust; and
              WHEREAS, the Trust is intended to be a "grantor trust" with the
     result that the corpus and income of the Trust are treated as assets and
     income of the Company pursuant to Sections 671 through 679 of the Code;
     and
              NOW, THEREFORE, in consideration of the mutual covenants herein
     contained, the Company and the Trustee declare and agree as follows:
     1.       DEFINITIONS; ESTABLISHMENT OF TRUST
              1.1.    DEFINITIONS.  Whenever used in this Trust Agreement,
     unless otherwise provided or the context otherwise requires:
                      AUTHORIZED OFFICER.  "Authorized Officer" means the
     Chairman, President, any Vice President, the Secretary or the Treasurer
     of the Company or any other person or persons as may be designated by
     the Company.
                      BOARD OF DIRECTORS.  "Board of Directors" means the
     board of directors of the Company.
                      CHANGE OF CONTROL.  "Change of Control" means any of
     the following events:
                      (a)    an acquisition by any individual, entity or
     group (within the meaning of Section 13(d)(3) or 14(d)(2) of the
     Securities Exchange Act of 1934, as amended (the "Exchange Act")) of
     beneficial ownership (within the meaning of Rule 13d-3 promulgated under
     the Exchange Act) of 50% or more of the combined voting power of the
     then outstanding voting securities of the Company; provided, however,
     that the following acquisitions shall not constitute a Change of
     Control:  (i) an acquisition by or directly from the Company, (ii) an
     acquisition by any employee benefit plan or trust sponsored or
     maintained by the Company; and (iii) any acquisition described in
     subclauses (A) or (B) of subsection (b) below; or
                      (b)  approval by the stockholders of the Company of (i)
     a complete dissolution or liquidation of the Company, (ii) a sale or
     other disposition of all or substantially all of the Company's assets or
     (iii) a reorganization, merger, or consolidation ("Business
     Combination") unless either (A) all or substantially all of the
     stockholders of the Company immediately prior to the Business
     Combination own more than 50% of the voting securities of the entity
     surviving the Business Combination, or the entity which directly or
     indirectly controls such surviving entity, in substantially the same
     proportion as they owned the voting securities of the Company
     immediately prior thereto, or (B) the consideration (other than cash
     paid in lieu of fractional shares or payment upon perfection of
     appraisal rights) issued to stockholders of the Company in the Business
     Combination is solely common stock which is publicly traded on an
     established securities exchange in the United States.
                      CODE.  "Code" means the Internal Revenue Code of 1986,
     as amended.
                      COMMITTEE.  "Committee" means a committee of officers
     selected by the Board of Directors, except as provided in Section 9.2,
     or by an individual or individuals authorized by the Board of Directors
     to make such selection which is charged with administration of the
     Trust.
                      COMPANY.  "Company" means Mid Atlantic Medical
     Services, Inc., a Delaware corporation, or any successor thereto. 
     References to the Company shall include its subsidiaries where
     appropriate.
                      COMPANY STOCK.  "Company Stock" means shares of common
     stock, par value $0.01 per share, issued by the Company or any successor
     securities.
                      EXTRAORDINARY DIVIDEND.  "Extraordinary Dividend" means
     any dividend or other distribution of cash or other property (other than
     Company Stock) made with respect to Company Stock, which the Board of
     Directors declares generally to be other than an ordinary dividend.
                      FAIR MARKET VALUE.  "Fair Market Value" means as of any
     date the closing price quotation, or, if none, the average of the bid
     and asked prices, as reported with respect to the Company Stock on the
     most recently available date, on any national exchange on which the
     Company Stock is then listed, or if not so listed, on the NASDAQ
     National Market, or other consolidated reporting system reporting trades
     of the Company Stock.  If the Company Stock is not so listed, "Fair
     Market Value" shall mean the average of the bid and asked prices as
     quoted by all market makers in the Company Stock.  In the event that a
     market for the Company Stock does not exist, the Committee may
     determine, in any case or cases, that "Fair Market Value" shall be
     determined on the basis of the opinion of one or more independent and
     reputable appraisers qualified to value companies in the Company's line
     of business.
                      INSOLVENCY.  "Insolvency" means (i) the inability of
     the Company to pay its debts as they become due, or (ii) the Company
     being subject to a pending proceeding as a debtor under the provisions
     of Title 11 of the United States Code (Bankruptcy Code).
                      LOAN.  "Loan" means the loan and extension of credit to
     the Trust evidenced by a  promissory note dated as of the Closing (as
     defined in the Amended and Restated Common Stock Purchase Agreement
     dated December 20, 1996, effective as of August 26, 1996, between the
     Trust and the Company (the Common Stock Purchase Agreement )) and,
     following cancellation of such promissory note, by the replacement
     promissory note dated as of the Rescission Closing (as defined in the
     Common Stock Purchase Agreement), with which the Trustee will purchase
     Company Stock.
                      OPTION GRANT.  "Option Grant" means an option granted
     under one of the Plans to a Plan Participant to acquire shares of
     Company Stock.
                      PLAN COMMITTEE CERTIFICATION.  "Plan Committee
     Certifications" means a certification to be provided to the Trustee by
     the Committee from time to time which (i) sets forth the number of
     shares of Company Stock transferred to a Plan Participant, and (ii)
     certifies that the determination of such number is in accordance with
     the terms of each Plan.
                      PLANS.  "Plans" means the employee plans listed on
     Schedule A hereto and any other employee benefit plan of the Company
     designated as such by the Board of Directors.
                      PLAN PARTICIPANT.  "Plan Participant" means an
     individual who has an Option Grant under any of the Plans.
                      RELIABLE SOURCE.  "Reliable Source" means (i) a report
     filed with the Securities and Exchange Commission, (ii) a public
     statement issued by the Company, or a periodical of general circulation,
     including, but not limited to, The NEW YORK TIMES or THE WALL STREET
     JOURNAL, or (iii) a certificate of the Company signed by the Chief
     Executive Officer or by the Chairman of the Board of Directors.
                      SUSPENSE ACCOUNT.  "Suspense Account" means the account
     in which shares of Company Stock acquired with the Loan are held until
     they are released pursuant to Section 3.1.
                      TRUST.  "Trust" means the trust established pursuant to
     this Trust Agreement.
                      TRUSTEE.  "Trustee" means Bank of New York or any
     successor trustee.
                      TRUST YEAR.  "Trust Year" means the period beginning on
     the date of the Closing (the "Closing Date") and ending on the next
     following December 31st and on each December 31st thereafter.
              1.2.    ESTABLISHMENT OF TRUST.
                      TRUST.  This Agreement and the Trust shall be known as
     the Mid Atlantic Medical Services, Inc. Stock Compensation Trust.  The
     parties intend that the Trust will be an independent legal entity with
     title to and power to convey all of its assets.  The parties hereto
     further intend that the Trust not be subject to the Employee Retirement
     Income Security Act of 1974, as amended.  The Trust is not a part of any
     of the Plans and does not provide retirement or other benefits to any
     Plan Participant.  The assets of the Trust will be held, invested and
     disposed of by the Trustee, in accordance with the terms of the Trust. 
     The Company covenants and agrees to at all times make available
     sufficient shares of Company Stock for purposes of the Plans to the
     extent that there are not sufficient shares in the Trust to meet the
     requirements of the Plans; provided, however, that the Trustee shall not
     be responsible for enforcing such obligation of the Company.
                      TRUSTEE.  The trustee named above, and its successor or
     successors, is hereby designated as the trustee hereunder, to receive,
     hold, invest, administer and distribute the Trust Fund in accordance
     with this Agreement, the provisions of which shall govern the power,
     duties and responsibilities of the Trustee.
                      TRUST FUND.  The assets held at any time and from time
     to time under the Trust collectively are herein referred to as the
     "Trust Fund" and shall consist of contributions received by the Trustee,
     proceeds of any loans, investments and reinvestment thereof, the
     earnings and income thereon, less disbursements therefrom.  Except as
     herein otherwise provided, title to the assets of the Trust Fund shall
     at all times be vested in the Trustee and securities that are part of
     the Trust Fund shall be held in such manner that the Trustee's name and
     the fiduciary capacity in which the securities are held are fully
     disclosed, subject to the right of the Trustee to hold title in bearer
     form or in the name of a nominee, and the interests of others in the
     Trust Fund shall be only the right to have such assets received, held,
     invested, administered and distributed in accordance with the provisions
     of the Trust.
                      IRREVOCABILITY.  The Trust Fund shall be used for the
     exclusive purpose of aiding the Company in delivering the benefits
     provided by the Plans and defraying the expenses of the Trust in
     accordance with this Trust Agreement.  The Trustee, however, is under no
     obligation to enforce the requirements set forth in the foregoing
     sentence.  No part of the income or corpus of the Trust Fund shall be
     recoverable by the Company except as provided in Sections 2.1, 2.2 and
     7.2 and except as provided in Article II of the Common Stock Purchase
     Agreement, with respect to the Rescission (as defined in such
     Agreement).
                      TRUST FUND SUBJECT TO CLAIMS.  Notwithstanding any
     provision of this Agreement to the contrary, the Trust Fund shall at all
     times remain subject to the claims of the Company's general creditors
     under federal and state law as set forth herein.
     2.       CONTRIBUTIONS AND DIVIDENDS
              2.1.    CONTRIBUTIONS.  For each Trust Year the Company shall
     contribute to the Trust in cash such amount, which together with
     dividends, as provided in Section 2.2, and any other earnings of the
     Trust Fund, shall enable the Trustee to make all scheduled payments of
     principal and interest due under the Loan on a timely basis.  Unless
     otherwise expressly provided herein, the Trustee shall apply all such
     contributions, dividends and earnings to the payment of principal and
     interest due under the Loan.  The Company may from time to time, in its
     sole discretion, make additional contributions to the Trust for the
     purpose of enabling the Trust to make prepayments of principal with
     respect to the Loan (a "Prepayment Contribution").  The Trustee shall
     immediately use any Prepayment Contribution to make a prepayment of
     principal with respect to the Loan.  All contributions made under the
     Trust shall be delivered to the Trustee.  The Trustee shall be
     accountable for all contributions received by it, but shall have no duty
     to require any contributions to be made to it.
              2.2.    DIVIDENDS.  Except as otherwise provided herein,
     dividends paid in cash on Company Stock held by the Trust, including
     Company Stock held in the Suspense Account, shall be applied to pay
     interest and repay scheduled principal due under the Loan.  In the event
     that cash dividends paid on Company Stock held in the Trust, other than
     Extraordinary Dividends, exceed the amount of scheduled principal and
     interest due in any Trust Year, such excess shall be used to purchase
     additional shares of Company Stock and/or shall be distributed to a
     broad cross-section of individuals employed by the Company, as
     determined in good faith by the Committee.  Dividends which are not in
     cash or in Company Stock (including Extraordinary Dividends, or portions
     thereof) shall be reduced to cash by the Trustee and reinvested in
     Company Stock as soon as practicable.  For purposes of this Agreement,
     Company Stock purchased with the proceeds of an Extraordinary Dividend,
     any excess dividend or with the proceeds of a non-cash dividend and any
     dividend paid in the form of Company Stock shall, for purposes of this
     Agreement (including without limitation Section 3.1 hereof), be deemed
     to have been acquired with the proceeds of the Loan.  In the Trustee's
     discretion, investments in Company Stock may be made through open-market
     purchases, private transactions or (with the Company's consent)
     purchases from the Company.  In carrying out the duties as set forth in
     this Section, the Trustee shall act solely pursuant to the directions of
     the Committee.
     3.      RELEASE AND ALLOCATION OF COMPANY STOCK
              3.1.    RELEASE OF SHARES.  Upon any payment (including a
     prepayment) or forgiveness in any Trust Year of any principal on the
     Loan (a "Principal Payment"), the following number of shares of Company
     Stock acquired with the proceeds of the Loan shall be available for
     allocation ("Available Shares") as provided in this Article 3:  the
     number of shares so acquired and held in the Suspense Account
     immediately before such payment or forgiveness, multiplied by a fraction
     the numerator of which is the amount of the Principal Payment and the
     denominator of which is the sum of such Principal Payment and the
     remaining principal of the Loan outstanding after such Principal
     Payment.
              3.2.    PAYMENT OF BENEFITS.  Available Shares shall be
     distributed, as directed by the Committee, to the Plan Participants at
     such times as may be required to provide shares in accordance with the
     Plans.  Any payments required by the Plan Participants shall be made in
     accordance with the Plans.
     4.       TAX WITHHOLDING
              4.1.    WITHOLDING OF TAXES.  The Trustee shall, as directed by
     the Committee, withhold, require withholding, or otherwise satisfy any
     withholding obligation, on any distribution which it is directed to
     make, such amount as the Committee shall reasonably estimate to be
     necessary to comply with applicable federal, state and local withholding
     requirements.  Upon settlement of such tax liability, the Trustee shall
     distribute the balance of such amount.  Prior to making any distribution
     hereunder, the Trustee may require such release of documents from any
     taxing authority, or may require such indemnity, as the Trustee shall
     reasonably deem necessary for its protection.
     5.       ADMINISTRATION OF TRUST FUND
              5.1.    MANAGEMENT AND CONTROL OF TRUST FUND.  Subject to the
     terms of this Agreement, the Trustee shall have exclusive authority and
     responsibility to manage and control the assets of the Trust Fund;
     provided, however, that the Trustee shall have no authority or
     responsibility to manage and control shares of Company Stock returned to
     the Company in connection with the Rescission from and after the date of
     the Rescission Closing (as such terms are defined in the Amended and
     Restated Common Stock Purchase Agreement, dated as of December 20, 1996,
     by and between the Company and the Trust).
              5.2.    INVESTMENT OF FUNDS.  Except as otherwise provided in
     Section 2.2 and in this Section 5.2, the Trustee shall invest and
     reinvest the Trust Fund exclusively in Company Stock, including any
     accretions thereto resulting from the proceeds of a tender offer,
     recapitalization or similar transaction which, if not in Company Stock,
     shall be reduced to cash as soon as practicable.  The Trustee may invest
     any portion of the Trust Fund temporarily pending investment in Company
     Stock, distribution or payment of expenses in (i) investments in United
     States Government obligations with maturities of less than one year,
     (ii) interest-bearing accounts including but not limited to certificates
     of deposit, time deposits, saving accounts and money market accounts
     with maturities of less than one year in any bank, including the
     Trustee's, with aggregate capital in excess of $1,000,000,000 and a
     ▇▇▇▇▇'▇ Investor Services rating of at least P1, or an equivalent rating
     from a nationally recognized ratings agency, which accounts are insured
     by the Federal Deposit Insurance Corporation or other similar federal
     agency, (iii) obligations issued or guaranteed by any agency or
     instrumentality of the United States of America with maturities of less
     than one year or (iv) short-term discount obligations of the Federal
     National Mortgage Association.
              5.3.    TRUSTEE'S ADMINISTRATIVE POWERS.  Except as otherwise
     provided herein, and subject to the Trustee's duties hereunder, the
     Trustee shall have the following powers and rights, in addition to those
     provided elsewhere in this Agreement or by law:
                      (a)     to retain any asset of the Trust Fund;
                      (b)     subject to Section 5.4 and Article 3, to sell,
     transfer, mortgage, pledge, lease or otherwise dispose of, or grant
     options with respect to, any Trust Fund assets at public or private
     sale;
                      (c)     upon direction from the Committee and with the
     Trustee's consent, to borrow from any lender (including the Company
     pursuant to the Loan), to acquire Company Stock as authorized by this
     Agreement, to enter into lending agreements upon such terms (including
     reasonable interest and security for the loan and rights to renegotiate
     and prepay such loan) as may be determined by the Committee; provided,
     however, that any collateral given by the Trustee for the Loan shall be
     limited to cash and property contributed by the Company to the Trust and
     dividends paid on Company Stock held in the Trust and shall not include
     Company Stock acquired with the proceeds of Loan;
                      (d)     with the consent of the Committee, to settle,
     submit to arbitration, compromise, contest, prosecute or abandon claims
     and demands in favor of or against the Trust Fund initiated by a party
     other than the Trustee;
                      (e)     to vote or to give any consent with respect to
     any securities, including any Company Stock, held by the Trust either in
     person or by proxy for any purpose, provided that the Trustee shall
     vote, tender or exchange all shares of Company Stock as provided in
     Section 5.4;
                      (f)     to exercise any of the powers and rights of an
     individual owner with respect to any asset of the Trust Fund and to
     perform any and all other acts that in its judgment are necessary or
     appropriate for the proper administration of the Trust Fund, even though
     such powers, rights and acts are not specifically enumerated in this
     Agreement;
                      (g)     to employ such accountants, actuaries,
     investment bankers, appraisers, other advisors and agents as may be
     reasonably necessary in collecting, managing, administering, investing,
     valuing, distributing and protecting the Trust Fund or the assets
     thereof or any borrowings of the Trustee made in accordance with Section
     5.3(c); and to pay their reasonable fees and out-of-pocket expenses,
     which shall be deemed to be expenses of the Trust and for which the
     Trustee shall be reimbursed in accordance with Section 4.1;
                      (h)     to cause any asset of the Trust Fund to be
     issued, held or registered in the Trustee's name or in the name of its
     nominee, or in such form that title will pass by delivery, provided that
     the records of the Trustee shall indicate the true ownership of such
     asset;
                      (i)     to utilize another entity as custodian to hold,
     but not invest or otherwise manage or control, some or all of the assets
     of the Trust Fund; and
                      (j)     to consult with legal counsel (who may also be
     counsel for the Trustee generally) with respect to any of its duties or
     obligations hereunder; and to pay the reasonable fees and out-of-pocket
     expenses of such counsel, which shall be deemed to be expenses of the
     Trust and for which the Trustee shall be reimbursed in accordance with
     Section 4.1.
     Notwithstanding the foregoing, neither the Trust nor the Trustee shall
     have any power to, and shall not, engage in any trade or business.  Any
     loan obtained by the Trustee pursuant to Section 5.3(c) shall be in its
     capacity as Trustee and not in its individual corporate capacity.
              5.4.    VOTING AND TENDERING OF COMPANY STOCK.
              (a)     Voting of Company Stock.  The Trustee shall follow the
     directions of each Plan Participant, as to the manner in which shares of
     Company Stock held by the Trust are to be voted on each matter brought
     before an annual or special stockholders' meeting of the Company or the
     manner in which any consent is to be executed, in each case as provided
     below.  Before each such meeting of stockholders, the Trustee shall
     cause to be furnished to each Plan Participant, a copy of the proxy
     solicitation material received by the Trustee, together with a form
     requesting confidential instructions as to how to vote the shares of
     Company Stock held by the Trustee.  Upon timely receipt of directions
     from the Plan Participants, the Trustee shall on each such matter vote
     the number of shares (including fractional shares) of Company Stock held
     by the Trust as follows:
                      The Company Stock shall be voted by the Trustee with
     each Plan Participant directing a number of shares of Company Stock (the
     "Participant Directed Amount") equal to the quotient of (x) the total
     number of shares of Company Stock held by the Trust and (y) the number
     of Plan Participants on the relevant date.  Any Participant Shares for
     which the Trustee does not receive a signed voting-direction instrument
     shall be voted for, against or to abstain in the same proportions as
     those shares of Company Stock for which the Trustee did receive
     instructions.
                      Similar provisions shall apply in the case of any
     action by shareholder consent without a meeting.
                      (b)     TENDER OR EXCHANGE OF COMPANY STOCK.  The
     Trustee shall use its best efforts timely to distribute or cause to be
     distributed to each Plan Participant any written materials distributed
     to stockholders of the Company generally in connection with any tender
     offer or exchange offer, together with a form requesting confidential
     instructions as to whether or not to tender or exchange shares of
     Company Stock held in the Trust.  Upon timely receipt of instructions
     from a Plan Participant, the Trustee shall tender such Participant's
     Participant Directed Amount if such Plan Participant has directed the
     Trustee to tender.  
                      (c)     The Company shall maintain appropriate
     procedures to ensure that all instructions by Participants in the Plans
     are collected, tabulated, and transmitted to the Trustee without being
     divulged or released to any person affiliated with the Company or its
     affiliates.  All actions taken by Plan Participants shall be held
     confidential by the Trustee and shall not be divulged or released to any
     person, other than (i) agents of the Trustee who are not affiliated with
     the Company or its affiliates or (ii) by virtue of the execution by the
     Trustee of any proxy, consent or letter of transmittal for the shares of
     Company Stock held in the Trust.
     6.       CONCERNING THE TRUSTEE
              6.1.    Notices to the Trustee.
                      The Trustee may rely on the authenticity, truth and ac-
     curacy of, and will be fully protected in acting upon:  
                      (a)  any notice, direction, certification, approval or
     other writing of the Company, if evidenced by an instrument signed in
     the name of the Company by an Authorized Officer; and
                      (b)  any copy of a resolution of the Board of Directors
     of the Company, if certified by the Secretary or an Assistant Secretary
     of the Company under its corporate seal; or
                      (c)  any notice, direction, certification, approval or
     other writing, oral or other transmitted form of instruction received by
     the Trustee and believed by it to be genuine and to be sent by or on
     behalf of the Committee.
              6.2.    EXPENSES OF THE TRUST FUND.
                   
                      The Trustee is authorized to pay out of the Trust Fund: 
     (a) all brokerage fees and transfer tax expenses and other expenses
     incurred in connection with the sale or purchase of investments; (b) all
     real and personal property taxes, income taxes and other taxes of any
     kind at any time levied or assessed under any present or future law
     upon, or with respect to, the Trust Fund or any property included in the
     Trust Fund; (c) the Trustee's compensation and expenses as provided in
     Section 6.3 hereof; and (d) all other expenses of administering the
     Trust, including, without limitation, the expenses incurred by the
     Trustee pursuant to Section 6.11 of this Agreement, if any, unless
     promptly paid to the Trustee by the Company.  
              6.3.    COMPENSATION OF THE TRUSTEE.
                      
                      The Company will pay to the Trustee such compensation
     for its services as set forth on Exhibit A as from time to time amended
     by the Company and the Trustee and will reimburse the Trustee for all
     expenses (including reasonable attorney's fees) incurred by the Trustee
     in the administration of the Trust.  If not promptly paid on request,
     the Trustee may charge such fees and expenses to and pay the same from
     the Trust Fund.  The compensation and expenses of the Trustee shall
     constitute a lien on the Trust Fund.
              6.4.    PROTECTION OF THE TRUSTEE.
                     
                      The Company shall pay and shall protect, indemnify and
     save harmless the Trustee and its officers, employees and agents from
     and against any and all losses, liabilities (including liabilities for
     penalties), actions, suits, judgments, demands, damages, costs and
     expenses (including, without limitation, attorneys' fees and expenses)
     of any nature arising from or relating to any action or any failure to
     act by the Trustee, its officers, employees and agents or the
     transactions contemplated by this Trust Agreement, including, but not
     limited to, any claim with respect to the Rescission (as such term is
     defined in the Common Stock Purchase Agreement), any claim by a 
     shareholder of the Company of any kind or nature, any claim made by a
     Plan Participant or his or her beneficiary with respect to payments made
     or to be made by the Trustee and any claim made by the Company or its
     successor, whether pursuant to a sale of assets, merger, consolidation,
     liquidation or otherwise, that this Trust Agreement is invalid or ultra
     ▇▇▇▇▇, except to the extent that any such loss, liability, action, suit,
     judgment, demand, damage, cost or expense has been determined by a final
     judgment of a court of competent jurisdiction to be solely the result of
     the gross negligence or 
     willful misconduct of the Trustee, its officers, employees or agents. 
     To the extent that the Company has not fulfilled its obligations under
     the foregoing provisions of this Section, the Trustee shall be
     reimbursed out of the assets of the Trust Fund or may set up reasonable
     reserves for the payment of such obligations.  The Trustee assumes no
     obligation or responsibility with respect to any action required by this
     Trust Agreement on the part of the Company or the Committee.  With
     respect to all action or inaction taken or not taken by the Trustee
     prior to the Rescission Closing, the rights of the Trustee shall 
     be determined in accordance with the terms and provisions of the Common
     Stock Purchase Agreement.
              6.5.    DUTIES OF THE TRUSTEE.
           
                      The Trustee will be under no duties whatsoever, except
     such duties as are specifically set forth as such in this Trust
     Agreement, and no implied covenant or obligation will be read into this
     Trust Agreement against the Trustee.  The Trustee will not be liable for
     any action or failure to act except if such action or failure to act
     constitutes gross negligence or willful misconduct.  The Trustee will
     not be compelled to take any action toward the execution or enforcement
     of the Trust or to prosecute or defend any suit in respect thereof,
     unless indemnified to its satisfaction against loss, cost, liability and
     expense; and the Trustee will be under no liability or 
     obligation to anyone with respect to any failure on the part of the
     Company, the Committee or a Plan Participant.  Nothing in this Trust
     Agreement shall be construed as requiring the Trustee to make any
     payment in excess of the amounts held in the Trust Fund at the time of
     such payment or otherwise to risk its own funds.  The Trustee has no
     duty to maintain records with respect to Option Grants or with respect
     to the shares in the Suspense Account.
              6.6.    SETTLEMENT OF ACCOUNTS OF THE TRUSTEE.
                      
                      The Trustee shall keep or cause to be kept accurate and
     detailed accounts of all investments, receipts, disbursements and other
     transactions hereunder.  Such accounts shall be open to inspection and
     audit at all reasonable times during normal business hours by any person
     designated by the Company or the Committee.  At least annually after the
     end of each Plan Year, the Trustee shall file with the Company and the
     Committee a written account, listing the investments of the Trust Fund
     and any uninvested cash balance thereof, and setting forth all receipts,
     disbursements, payments, and other transactions respecting the Trust
     Fund not included in any such previous account.  Any account, when
     approved by the Company and the Committee, will be binding and
     conclusive on the Company, the Committee and all Plan Participants, and
     the Trustee will thereby be released and discharged from any liability
     or accountability to the Company, the Committee and all Plan
     Participants with respect to all matters set forth therein.  Omission by
     the Company or the Committee to object in writing to any specific items
     in any such account within sixty (60) days after its delivery will
     constitute approval of the account by the Company and the Committee.  No
     other accounts or reports shall be required to be given to the Company,
     the Committee or a Plan Participant except as stated herein or except as
     otherwise agreed to in 
     writing by the Trustee.  The Trustee shall not be required to file, and
     no Plan Participant or beneficiary shall have right to compel, an
     accounting, judicial or otherwise, by the Trustee.
              6.7.    RIGHT TO JUDICIAL SETTLEMENT.
                 
                      Nothing contained in this Trust Agreement shall be
     construed as depriving the Trustee of the right to have a judicial
     settlement of its accounts, and upon any proceeding for a judicial
     settlement of the Trustee's accounts or for instructions the only
     necessary parties thereto in addition to the Trustee shall be the
     Company and the Committee.
              6.8.    RESIGNATION OR REMOVAL OF THE TRUSTEE.
                      
                      The Trustee may at any time resign and may at any time
     be removed by the Company upon thirty (30) days' notice in writing.
              6.9.    APPOINTMENT OF SUCCESSOR TRUSTEE.
               
                     In the event of the resignation or removal of the
     Trustee, or in any other event in which the Trustee ceases to act, a
     successor trustee may be appointed by the Company by instrument in
     writing delivered to and accepted by the successor trustee. Notice of
     such appointment and approval, if applicable, will be given by the
     Company to the retiring trustee, and the successor trustee will deliver
     to the retiring trustee an instrument in writing accepting such
     appointment.  Notwithstanding the foregoing, if no appointment and
     approval, if applicable, of a successor trustee is made by the 
     Company within a reasonable time after such a resignation, removal or
     other event, any court of competent jurisdiction may appoint a successor
     trustee after such notice, if any, solely to the Company and the
     retiring trustee, as such court may deem suitable and proper.
              In the event of such resignation, removal or other event, the 
     retiring trustee or its successors and assigns shall file with the
     Company a final account to which the provisions of Section 6.6 hereof
     relating to annual accounts shall apply.
              In the event of the appointment of a successor trustee, such 
     successor trustee will succeed to all the right, title and estate of,
     and will be, the Trustee; and the retiring trustee will after the
     settlement of its final account and the receipt of any compensation or
     expenses due it, deliver the Trust Fund to the successor trustee
     together with all such instruments of transfer, conveyance, assignment
     and further assurance as the successor trustee may reasonably require. 
     The retiring trustee will retain a lien upon the Trust Fund to secure
     all amounts due the retiring trustee pursuant to the provisions of this
     Trust Agreement.
              6.10.   MERGER OR CONSOLIDATION OF THE TRUSTEE.
                      
                      Any corporation continuing as the result of any merger
     or resulting from any consolidation to which merger or consolidation the
     Trustee is a party, or any corporation to which substantially all the
     business and assets of the Trustee may be transferred, will be deemed
     automatically to be continuing as the Trustee.
              6.11.   DECLARATORY JUDGMENT.  Effective on and after December
     20, 1996, the Trustee may, prior to taking any action pursuant to this
     Agreement with respect to which the Trustee determines in good faith
     that the legality or permissibility of such action under this Agreement
     or otherwise is questionable, seek a declaratory judgment from a court
     of competent jurisdiction as to such legality or permissibility.
     7.       ENFORCEMENT; INSOLVENCY OF THE COMPANY
              
              7.1.    ENFORCEMENT OF TRUST AGREEMENT AND LEGAL PROCEEDINGS.
                      
                      The Company shall have the right to enforce any provi-
     sion of this Trust Agreement.  In any action or proceeding affecting the
     Trust, the only necessary parties shall be the Company, the Trustee and
     the Committee and, except as otherwise required by applicable law, no
     other person shall be entitled to any notice or service of process.  Any
     judgment entered in such an action or proceeding shall, to the maximum
     extent permitted by applicable law, be binding and conclusive on all
     persons having or claiming to have any interest in the Trust.
              7.2.    INSOLVENCY OF THE COMPANY.
                      (a) If at any time (i) the Company or a person claiming
     to be a creditor of the Company alleges in writing to the Trustee that
     the Company has become Insolvent, (ii) the Trustee is served with any
     order, process or paper from which it appears that an allegation to the
     effect that the Company is Insolvent has been made in a judicial
     proceeding or (iii) the Trustee has actual knowledge of a current report
     or statement from a nationally recognized credit reporting agency or
     from a Reliable Source to the effect that the 
     Company is Insolvent, the Trustee shall discontinue allocations under
     Section 3 under this Trust Agreement, shall hold the Trust Fund for the
     benefit of the Company's creditors, and shall resume allocations under
     Section 3 under this Trust Agreement, only upon receipt of an order of a
     court of competent jurisdiction requiring such payment or if the Trustee
     has actual knowledge of a current report or statement from a nationally
     recognized credit reporting agency or other Reliable Source (other than
     a Reliable Source described in clause (iii) of the definition thereof)
     to the effect that the Company is not Insolvent; provided, however, that
     in the event that allocations under Section 
     3 were discontinued by reason of a court order or injunction, the
     Trustee shall resume allocations only upon receipt of an order of a
     court of competent jurisdiction requiring such allocation.  The Company
     and its Chief Executive Officer shall be obligated to give the Trustee
     prompt written notice in the event that the Company becomes Insolvent. 
     The Trustee shall not be liable to anyone in the event benefit payments
     are discontinued pursuant to this Section 7.2.  For purposes of this
     Section 7.2, the term Company shall include any and all of the Company's
     subsidiaries. The Company hereby specifically represents 
     and warrants to the Trustee that, as of December 20, 1996, neither the
     Company nor any subsidiary of the Company with one or more employees
     benefiting under the Plans is Insolvent.
     8.  AMENDMENT, REVOCATION AND TERMINATION
                      8.1.  AMENDMENTS.  Except as otherwise provided herein,
     the company may amend the Trust at any time and from time to time in any
     manner which it deems desirable, provided that no amendment which would
     adversely affect the rights, duties, interests, fees or obligations of
     the Trustee shall be made without the Trustee's written consent, which
     consent shall not be unreasonably withheld.  Notwithstanding the
     foregoing, the Company shall retain the power under all circumstances to
     amend the Trust to correct any errors or clarify any ambiguities or
     similar issues of interpretation in this Agreement.
                      8.2.  TERMINATION.  Subject to the terms of this
     Section 8.2, the Trust shall terminate on the later of (i) the date all
     Available Shares are distributed and (ii) the date on which the Loan is
     paid in full (the "Termination Date").  The Company may terminate the
     Trust at any time prior to the Termination Date.  The Trust shall also
     terminate automatically upon the Company giving the Trustee written
     notice of a Change of Control (The Trustee shall have no duty to
     authenticate the occurrence of a Change of Control).  
     Immediately upon a termination of the Trust, the Company shall be deemed
     to have forgiven all amounts then outstanding under the Loan.  As soon
     as practicable after receiving notice from the Company of a Change of
     Control or upon any other termination of the Trust, the Trustee shall
     sell all of the Company Stock and other non-cash assets (if any) then
     held in the Trust Fund as directed by the Committee in good faith taking
     into account the interests of a broad cross-section of individuals em-
     ployed by the Company.  The proceeds of such sale shall first be
     returned to the Company up to an amount equal to 
     the principal amount, plus any accrued interest, of the Loan that was
     forgiven upon such termination.  Any funds remaining in the Trust after
     such payment to the Company (the "Excess Funds") shall be allocated and
     distributed with reasonable promptness to Plan Participants among a
     broad cross-section of the Company's employees as determined by the
     Committee.
                      8.3.  FORM OF AMENDMENT OR TERMINATION.  Any amendment
     or termination of the Trust shall be evidenced by an instrument in
     writing signed by an Authorized Officer of the Company, certifying that
     said amendment or termination has been authorized and directed by the
     Company or the Board of Directors, as applicable, and, in the case of
     any amendment, shall be consented to by signature of an authorized
     officer of the Trustee, if required by Section 8.1.
     9.       MISCELLANEOUS PROVISIONS
              9.1.    SUCCESSORS.
                      
                      This Trust Agreement shall be binding upon and inure to
     the benefit of the Company and the Trustee and their respective
     successors and assigns.
              9.2. COMMITTEE ACTION.
                      Any action required or permitted to be taken by the
     Committee may be taken on behalf of the Committee by any individual so
     authorized.  The Company (or the Committee after a Change of Control)
     shall furnish to the Trustee the name and specimen signature of each
     member of the Committee upon whose statement of a decision or direction
     the Trustee is authorized to rely. Until notified of a change in the
     identity of such person or persons, the Trustee shall act upon the
     assumption that there has been no change.  After the Company has given
     the Trustee notice that a Change of Control has occurred, the Board of
     Directors shall no longer have the authority to remove or appoint
     members of the Committee and the members of the Committee in place 
     immediately preceding such a Change of Control shall continue as such
     members and shall appoint new members to replace any members who resign
     or otherwise cease to be members after the Change of Control. 
              9.3.    NONALIENATION.
                      
                      Except insofar as applicable law may otherwise require,
     (a) no amount payable to or in respect of any Plan Participant at any
     time under the Trust shall be subject in any manner to alienation by
     anticipation, sale, transfer, assignment, bankruptcy, pledge,
     attachment, charge or encumbrance of any kind, and any attempt to so
     alienate, sell, transfer, assign, pledge, attach, charge or otherwise
     encumber any such amount, whether presently or thereafter payable, shall
     be void; and (b) the Trust Fund shall in no manner 
     be liable for or subject to the debts or liabilities of any Plan
     Participant.
              9.4.    COMMUNICATIONS.
                      (a)  Communications to the Company shall be addressed
     to the Company at ▇ ▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇, ▇▇  ▇▇▇▇▇ Attn:  ▇▇▇▇▇▇ ▇.
     ▇▇▇▇▇▇▇▇▇▇, provided, however, that upon the Company's written request,
     such communications shall be sent to such other address as the Company
     may specify.
                      (b)  Communications to the Trustee shall be addressed
     to it at ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇, Attn:  Division
     Head, Master Trust/Custody Division; provided, however, that upon the
     Trustee's written request, such communications shall be sent to such
     other address as the Trustee may specify.
                      (c)  No communication shall be binding on the Trustee
     until it is received by officer the Trustee having primary responsi-
     bility for this Trust, and no communication shall be binding on the
     Company until it is received by the Company.
              9.5.    HEADINGS.
                      
                      Titles to the Sections of this Trust Agreement are
     included for convenience only and shall not control the meaning or
     interpretation of any provision of this Trust Agreement.
              9.6.    THIRD PARTIES.
                      
                      A third party dealing with the Trustee shall not be
     required to make inquiry as to the authority of the Trustee to take any
     action nor be under any obligation to follow the proper application by
     the Trustee of the proceeds of sale of any property sold by the Trustee
     or to inquire into the validity or propriety of any act of the Trustee.
              9.7.    GOVERNING LAW.
                      This Trust Agreement and the Trust established
     hereunder shall be governed by and construed, enforced, and administered
     in accordance with the internal laws of the State of New York without
     regard to principles of conflicts of laws and the Trustee shall be
     liable to account only in the courts of that state.
              9.8.    COUNTERPARTS.
                      
                      This Trust Agreement may be executed in any number of 
     counterparts, each of which shall be deemed to be the original although
     the others shall not be produced.
              IN WITNESS WHEREOF, this Trust Agreement has been duly executed
     by the parties hereto as of the day and year first above written.
                                        MID ATLANTIC MEDICAL SERVICES, INC.
                                        By:  /S/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇▇▇
                                            --------------------------        
                 
     Attest
      /S/ ▇▇▇▇▇ ▇▇▇▇▇▇▇▇
     --------------------
       
                                                 THE BANK OF NEW YORK, as 
                                                 TRUSTEE
                                                 By:  /S/  ▇▇▇▇▇▇ ▇. ▇▇▇▇▇    
                                                    ---------------------- 
                                               
     Attest
     /S/ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇-▇▇▇▇▇▇
     ---------------------------
                                       SCHEDULE A
                                       ----------
                                  MAMSI 1990 Non-Qualified Stock Option Plan
                                  MAMSI 1991 Non-Qualified Stock Option Plan
                                  MAMSI 1992 Non-Qualified Stock Option Plan
                                  MAMSI 1993 Non-Qualified Stock Option Plan
                                  MAMSI 1994 Non-Qualified Stock Option Plan
                                  MAMSI 1995 Non-Qualified Stock Option Plan
                                  MAMSI 1996 Non-Qualified Stock Option Plan
                                      The Bank of New York
                                        Schedule of Fees
                                               for
                                      Grantor Trust Services
                                               for
                                 MID ATLANTIC MEDICAL SERVICES, INC.
     The following schedule of fees would apply to the subject trust.  Fees
     are rendered quarterly.
     Administration Fees:                       $15,000 annually
     Special Asset Fee:
     $10,000 per annum for the first company stock account held as an asset
     per issuer.
     $3,000 per annum for each additional account.
     Transaction Fees:
     Security Transaction                       $15.00 per security
                                                 transaction
     Lump Sum/Expense Payments                  $12.50 per check plus postage
     Periodic Payments                          $2.00 per check plus postage
     Wire Transfers (outgoing)                  $15.00 per transfer
     Special Transaction Fees
     Change of Control                          $10,000 per event
     Insolvency                                 $10,000 per event
     Termination of the Trust                   $3,000 per event
     Tax Form Preparation                       $150 per hour as incurred
     Convert to Pay Status                      $100 per participant
     Proxy Services                             $150/hour
     Corporate Action Administrative Services   $150/hour
     Legal Fees/Out-of-Pocket Expenses          As Incurred
     Special Reporting Fees - Sub Plan Accounting
     $1,500 annually per investment pool
     $250 per plan within each pool
     Fees as quoted above do not include any direct out-of-pocket or legal
     expenses which would become payable in accordance with the grantor trust
     agreement.  There are no initial set-up fees, except legal fees,
     incurred with the establishment/conversion of the trust to The Bank of
     New York.
                                            Exhibit A