Standard Security Life Insurance Company of New York
Insured: ________________________
Group Name: University of Wisconsin - Stout
Policy #: SSH0000221	Effective Date: 09/01/2010
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. 1-877-775-5430 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: www.maksin.com