National Union Fire Insurance Company of Pittsburgh, Pa.
Insured: ________________________
Group Name: University of the District of Columbia
Policy #: CHH0087182   Effective Date: 08/01/2011
Identification No.: ________________________

The Covered Person on the reverse side of this card, and such dependents as are listed on the enrollment form are entitled to the benefits stated in the plan.

For benefits please call:
Maksin Management Corp.

Send your itemized medical and hospital bills to:
Maksin Management Corp.
PO Box 2647
Camden, NJ 08101-2647

To secure a claim form, go to:

NEIC# 22195

Bin: 003858
Processor Control: A4
Group: AQ3A