103 Non-Specialty Drugs: For appeals of denied claims that do not involve Specialty Drugs, CVS Caremark will notify you of a decision within 30 days of receipt of your request for review. Specialty Drugs: For appeals not involving Urgent Claims, CVS Caremark will notify you of its decision within a reasonable period of time appropriate to the medical circumstances, but in no event will CVS Caremark take more than 15 days to notify you of its decision. Urgent Claim: If the Specialty Medication appeal involves a denied Urgent Claim, CVS Caremark will decide the appeal as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the appeal. If CVS Caremark denies your appeal, you have the right to request a second level appeal with the Board of Trustees of the National IAM Benefit Trust Fund. B. Second Level Appeal If CVS Caremark denies your appeal, you have the right to request a second level appeal with the Board of Trustees of the National IAM Benefit Trust Fund. You should submit your second level appeal to the Fund Office after you receive the first level appeal denial, but within 90 days of receipt of CVS Caremark’s denial notice on the first level appeal review. Your second level appeal should include a copy of the first level appeal denial, and any information supporting your appeal. Second level appeals received more than 90 days after receipt of the notice of denial of the first level appeal will be denied as untimely. The Board of Trustees will review your appeal on the date of the first Board meeting that immediately follows the Plan’s receipt of your request for review, unless the request for review is filed within 30 days preceding the date of such meeting. In such case, a benefit determination may be made on the date of the second meeting following the Plan’s receipt of the request for review. If special circumstances require a further extension of time for processing, a determination will be made no later than the third meeting following the initial receipt of the appeal. If an extension is required, you will be notified of the extension and the reasons for it prior to the commencement of the extension. If the Specialty Medication appeal is related to a denied Urgent Claim, the final decision on the appeal will be made as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the appeal by the Fund Office. External Review of Adverse Benefit Determination after Internal Appeal Generally, health benefit claims are handled directly by CareFirst Administrators if you use a provider in the CareFirst Administrators network. After you have exhausted the Plan’s internal claims and appeals process, you may exercise your option to seek an external review with an Independent Review Organization (IRO) that conducts reviews of adverse benefit determinations. This External Review process is intended to comply with the Affordable Care Act’s external review requirements. If you are not literate in English, depending on the county in which you reside, you may be eligible for assistance in the non-English language in which you are literate. Call the Fund Office at 202-785-8148 or toll-free at 800-457-3481 for more information.