99 • A statement of your right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review. • If an internal rule, guideline or protocol was relied upon in deciding your claim, you will receive either a copy of the rule, or a statement that such a rule was relied upon in deciding the claim and that a copy will be provided to you upon request at no charge. • If the determination was based on the absence of Medical Necessity, or because the treatment was experimental or investigational, or other similar exclusion, you will receive an explanation of the scientific or clinical judgment for the determination applying the terms of the Plan to your claim, or a statement that it is available upon request at no charge. • If the adverse benefit determination involves urgent care, a statement of the expedited review process applicable to such claims. An adverse determination involving urgent care may be provided orally, provided written notification is provided not later than three calendar days after the oral notification. If a Pre-Service claim is approved, you will receive written (or electronic, as applicable) notice within fifteen (15) days of the appropriate Claims Administrator’s receipt of the claim. Notice of Approval of an Urgent Care Claim will be provided in writing (or electronically, as applicable) to you and your health care professional within the applicable timeframe after the Claims Administrator’s receipt of the claim. Internal Appeals for Health Claims A. First Level Appeal • Medical Benefits Appeal • Pre-Service Claims If you disagree with Quantum Health or CareFirst Administrator’s decision on any of your Pre- Service Claims for medical benefits, you may submit an appeal to the appropriate Claims Administrator as stated in the notice of adverse benefit determination. Your request for appeal review must be made in writing within 180 days of receipt of your denial notice and should be submitted to the appropriate Claims Administrator noted above. You should state the reason why you feel your appeal should be approved and include any information supporting your appeal. Your appeal will be reviewed by someone not involved in the initial decision. Note: You must first file your internal appeal with the appropriate Claims Administrator as you initiate the Appeals process. First level appeals received more than 180 days after receipt of the notice of the denial or adverse determination of the claim will be denied as untimely. The Claims Administrator will respond in writing to your appeal no later than 15 calendar days (for pre-service claims) or 30 calendar days (for post-service claims) after the appeal is received. In ruling on such first level appeals, the applicable Claims Administrator, CareFirst Administrators, or Quantum Health serves in the capacity of a named fiduciary under ERISA. • Eligibility Appeal • If you are appealing an adverse determination relating to eligibility, your appeal must be made to the Board of Trustees in writing within 180 days after receipt of the determination notice. Appeals received more than 180 days after receipt of the notice will be denied as untimely.