ADDENDUM NO. 4

   1
                                                                   Exhibit 10.34

                                 ADDENDUM NO. 4

                                     to the

          COMBINED QUOTA SHARE, AGGREGATE AND SPECIFIC EXCESS OF LOSS
                               REINSURANCE TREATY

               (hereinafter referred to as "Reinsurance Treaty")

                                   issued to

                 MEDICAL INTER-INSURANCE EXCHANGE OF NEW JERSEY
                           Lawrenceville, New Jersey

                 (hereinafter referred to as "Ceding Company")

                                       by

                   THE REINSURERS SUBSCRIBING THE RESPECTIVE
                      INTERESTS AND LIABILITIES AGREEMENTS

                   (hereinafter referred to as "Reinsurers")

The Ceding Company and the Reinsurers hereby agree to amend the captioned 
Reinsurance Treaty, effective November 1st, 1998, with respect to business 
ceded for the 1999 Coverage Year and thereafter, as follows:-

                            ARTICLE 27: INTERMEDIARY


Xxxxx Xxxxxxxx Ltd, 0 Xxxxxxxx Xxxxxx, Xxxxxx XX0X 0XX is hereby recognized as 
the intermediary negotiating this Treaty for all business hereunder and through 
whom all communication relating hereto (including but not limited to notices, 
statements and reports) shall be transmitted to both parties. It is understood, 
as regards remittances due either party hereunder, that payment by the Ceding 
Company to the Intermediary, shall constitute payment to the Reinsurers but 
payment by the Reinsurer to the Intermediary shall only constitute payment to 
the Ceding Company to the extent such payments are actually received by the 
Ceding Company. Notwithstanding the foregoing, it is agreed that all payments 
will be direct from the Reinsurer to the Ceding Company, or from the Ceding 
Company to the Reinsurer as appropriate.