“The law does not require Advocate to offer anything more,” the motion states, adding that the program ensures individuals can qualify for the reward at least once annually, as mandated by the regulations.
Advocate’s Arguments for Dismissal
Advocate Aurora Health makes several key arguments to support its motion to dismiss:
- Retroactive Reimbursement Not Required: Advocate asserts that ERISA does not mandate retroactive reimbursement for late enrollees in wellness programs. Instead, its pro-rated approach is permissible and compliant with the law.
- Lack of Specificity: The plaintiffs’ claims that the cessation program is “unreasonably strict” are unsupported by any standard or tied to their personal experiences, rendering them conclusory and insufficient.
- Failure to Exhaust Administrative Remedies: Advocate contends the plaintiffs did not exhaust the claims and appeals process outlined in their health plans before filing suit, a procedural requirement under ERISA.
- Pro-Compliance Design: Advocate highlights that its program goes beyond what the law requires by allowing late enrollees to join and benefit from reduced surcharges mid-year, even though it is not obligated to do so.
Plaintiff Allegations
The plaintiffs, who filed the proposed class action in September, argue that Advocate Aurora’s surcharge unfairly penalizes employees who do not enroll in the cessation program by January. They claim the lack of retroactive reimbursements for late enrollees violates ERISA’s anti-discrimination provisions.
