Exhibit (a)(18)
                               CII FINANCIAL, INC.
                     California Indemnity Insurance Company
                      Commercial Casualty Insurance Company
                  subsidiaries of Sierra Health Services, Inc.
                  P O. Box 15645, Las Vegas, Nevada 89114-5645

                                  PRESS RELEASE

FOR IMMEDIATE RELEASE

CONTACTS: John Okita                        Andrew C. Karp
          Chief Financial Officer           Managing Director
          (702) 242-7531                    Banc of America Securities LLC
                                            High Yield Special Products
                                            (704) 388-4813 or (888) 292-0070

     CII FINANCIAL ANNOUNCES REVISED TERMS OF EXCHANGE OFFER FOR CONVERTIBLE
            SUBORDINATED DEBENTURES AND EXTENSION OF EXPIRATION DATE


         Las Vegas,  April 2, 2001 - CII  Financial,  Inc.  today  announced the
amendment of its pending exchange offer for all $47 million of its outstanding
7 1/2%  convertible  subordinated  debentures  due  September  15, 2001
(CUSIP No. 12551LAB7).  Under the offer,  holders can choose to  exchange
their old 7 1/2% junior subordinated debentures for either new senior debentures
 or cash.

         The  Company  said  the  revised  terms  of the  offer  consist  of the
following:

- -     The cash purchase price has been increased from $525 per $1,000 principal
      amount to $700 per $1,000 principal amount, plus accrued interest.

- -     The funds  available to finance the offer have been increased from
      $10,237,500  to  $20,000,400.  As a  result,  the  Company  is now
      offering to buy a total of $28,572,000  principal  amount of old 7
      1/2% subordinated debentures, or 60.7%, for cash.

- -     The Company is offering to exchange the remaining $18,487,000 principal
      amount of old 7 1/2% subordinated debentures for new senior debentures.

                                   ---more---

CII Announces Revised Terms p. 2/2/2/2/2

- -             The interest rate on the new senior  debentures has been increased
              from 9% to 9 1/2%.  In  addition,  the  maturity of the new senior
              debentures has been shortened from September 15, 2006 to March 31,
              2005.

- -             The new 9 1/2% senior  debentures  will be senior  indebtedness of
              CII  Financial  and will rank  senior  to all other  indebtedness,
              including any remaining old 7 1/2%  subordinated  debentures.  The
              new 9 1/2%  senior  debentures  will  also  rank  senior  to  CII
              Financial's  guaranty of the $135 million  credit  facility of the
              Company's  parent,  Sierra  Health  Services,   Inc.,  subject  to
              majority approval by the bank group.

- -             In the event of a change of control of CII  Financial,  holders of
              the new 9 1/2%  senior  debentures  will have the right to require
              the  Company to  repurchase  their new  debentures  at 100% of the
              principal  amount,  plus a specified  premium declining over time.
              The repurchase premium will initially be 5%.

         Under the amended  offer,  holders who elect cash will  receive $700 in
cash  for  each  $1,000  principal  amount  of  their  old 7  1/2%  subordinated
debentures  accepted under the cash option,  plus accrued and unpaid interest in
cash. If holders of more than $28.6 million total principal amount of old 7 1/2%
subordinated  debentures  elect to sell their  debentures  for cash, the Company
will  purchase  a  total  of  $28.6  million  principal  amount  of  old 7  1/2%
subordinated  debentures  for cash and the Company will  exchange the balance of
the tendered debentures for new 9 1/2% senior debentures.  All holders who elect
to receive cash will be treated  equally in this  process.  It is a condition of
the offer, as amended, that at least $28.6 million total principal amount of old
7 1/2% subordinated debentures be tendered for cash.

         As a result of the  revisions,  holders  who  elect  new 9 1/2%  senior
debentures will receive $1,000 principal amount of new 9 1/2% senior  debentures
for each $1,000  principal amount of their old 7 1/2%  subordinated  debentures,
plus accrued and unpaid  interest in cash.  It is a condition  of the offer,  as
amended,  that the  Company  will  exchange  no more than  $18.5  million  total
principal  amount of old 7 1/2%  subordinated  debentures  for new 9 1/2% senior
debentures.

         The expiration  date for the exchange offer has been extended from 5:00
p.m.,  New York City time, on April 2, 2001, to 11:59 p.m.,  New York City time,
on April 12, 2001. The Company filed an amended Registration  Statement with the
Securities and Exchange Commission on March 30, 2001.

         The Company said that, prior to revising the terms of the offer, it had
received  tenders from holders of $14,776,000 in aggregate  principal  amount of
debentures as of 5:00 p.m., New York City time, on March 30, 2001.

                                   ---more---

CII Announces Revised Terms p. 3/3/3/3/3

         The  complete  terms of the offer,  as amended,  are  contained  in the
amended Preliminary Prospectus and Exchange Offer dated March 30, 2001.

     Banc of America  Securities  LLC is the  exclusive  dealer  manager for the
offer.  D.F. King & Co., Inc. is the information agent and Wells Fargo Corporate
Trust is the depositary. Copies of the Preliminary Prospectus and Exchange Offer
may be obtained by calling D.F. King at (800) 735-3591.  Additional  information
concerning  the terms and  conditions of the offer may be obtained by contacting
Banc of America Securities LLC at (888) 292-0070.

         CII  Financial  is a  holding  company  primarily  engaged  in  writing
workers'  compensation  insurance in nine western and mid-western states through
its  wholly  owned   subsidiaries,   California   Indemnity  Insurance  Company,
Commercial Casualty Insurance Company, Sierra Insurance Company of Texas and CII
Insurance  Company.  CII Financial is a wholly owned subsidiary of Sierra Health
Services,  Inc. (NYSE:SIE),  a diversified health care services company based in
Las Vegas.

         Statements  in this  news  release  that are not  historical  facts are
forward-looking   and  based  on  management's   projections,   assumptions  and
estimates;  actual results may vary materially.  Forward-looking  statements are
subject to certain  risks and  uncertainties,  some of which may be found in the
Preliminary  Prospectus  and Exchange Offer and other  documents  filed with the
Securities  and  Exchange  Commission  and  which  are  incorporated  herein  by
reference.

         Additional Information and Where to Find It:

         CII  Financial,  Inc.  has  filed a  Registration  Statement  with  the
Securities and Exchange Commission on Form S-4 registering the new debentures to
be issued in the exchange offer. The Registration  Statement and the preliminary
prospectus contained therein contain important  information about CII Financial,
the exchange offer and related  matters.  Security holders are urged to read the
Registration  Statement and the preliminary  prospectus  contained therein,  CII
Financial's  Schedule TO and any other relevant documents filed by CII Financial
with the SEC.

         The  Registration  Statement  has not  yet  become  effective.  The new
debentures  may not be sold and,  although  you may tender your old  debentures,
tenders may not be accepted prior to the time the Registration Statement becomes
effective.  This  shall not  constitute  an offer to sell or an offer to buy nor
shall there be any sale of the new  debentures in any State in which such offer,
solicitation or sale would be unlawful.

         Security  holders  are  able  to  obtain  copies  of  the  Registration
Statement on Form S-4 and the preliminary  prospectus,  CII Financial's Schedule
TO and any other relevant  documents for free through the Web site maintained by
the SEC at http://www.sec.gov.  In addition,  these documents are available free
of charge by contacting the Information Agent for the offer, D.F. King & Co., at
(800)  735-3591.  If you have any  questions  about the offer,  please  call the
Dealer Manager for the offer, Banc of America Securities LLC, at (888) 292-0070.

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