71 Claims Filing and Appeal Procedures This Section of the SPD describes the procedures for filing claims and benefits as provided under the terms of the National IAM Benefit Trust Fund. It also describes the procedures for you to follow if your claim is denied in whol e or in part and you wish to appeal the decision. The Plan’s internal claims and appeal procedures are designed to provide you with full, fair, and fast claim review and so that Plan provisions are applied consistently with respect to you and other similar ly situated participants. In addition, the Plan must consult with a health care professional with appropriate training and experience when reviewing an adverse benefit determination that is based in whole o r in part on a medical judgment (such as a determi nation that a service is not medically necessary or appropriate, or is Exp erimental or Investigational). The internal claims process pertains to determinations made by the appropriate Claims Administrator about whether a request for benefits (known as a “claim”) is payable. If the appropriate Claims Administrator denies your claim for benefits (known as an “adverse benefit determination”), you have the right to appeal the denied claim under the Plan’ s inter nal appeals process. For health benefits, you may be able to seek an external review with an Independent Review Organization (IRO) that conducts reviews of adverse benefit determinations either (i) after the Plan’s internal appeals process has been exhaust ed, or (ii) under limited circumstances before the Plan’s internal claims and appeals process have been exhausted. Appropriate Claims Administrator Types of Claims Processed Cigna Appeals Unit P.O. Box 188011 Chattanooga, TN 37422 - 8011 Phone: 1 - 800 - 244 - 6 224 TTY/TDD: 1 - 800 - 735 - 2929 or 1 - 888 - 877 - 5378 Fax: 1 - 877 - 815 - 4827 www.mycigna.com • Medical Claims CVS Caremark, Inc. 9501 East Shea Blvd. Scottsdale, AZ 85260 - 6719 Phone: 888 - 727 - 5575 www.cvscaremark.com • Prescription Drug Claims Board of Trustees National IAM Benefit Trust Fund 1300 Connecticut Avenue, NW, Suite 300 Washington, DC 20036 www.iambtf.org • Eligibility Determinations • Second - Level Appeal