Andrea D. Greene, et al. v. Progressive Corporation

CourtDistrict Court, N.D. Ohio
DecidedMarch 20, 2026
Docket1:24-cv-01890
StatusUnknown

This text of Andrea D. Greene, et al. v. Progressive Corporation (Andrea D. Greene, et al. v. Progressive Corporation) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Andrea D. Greene, et al. v. Progressive Corporation, (N.D. Ohio 2026).

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF OHIO EASTERN DIVISION

ANDREA D. GREENE, et al., ) CASE NO. 1:24-cv-01890 ) Plaintiffs, ) JUDGE DAVID A. RUIZ ) -vs- ) ) MEMORANDUM OPINION AND ORDER PROGRESSIVE CORPORATION, ) ) Defendant. )

Pending before the Court is the Motion to Dismiss filed by Defendant Progressive Corporation (“Progressive”). (R. 13). Plaintiffs Andrea D. Greene and James M. Vaughan allege they “are current and former employees who paid [a] tobacco surcharge and/or paid [a] vaccine surcharge to maintain health insurance coverage” under the Progressive Health Life And Disability Benefits Plan (the “Plan”). (R. 1, PageID# 2, ¶¶4-5). Plaintiffs allege five counts against Defendant: (1) unlawful imposition of a discriminatory tobacco surcharge in violation of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1182; (2) unlawful imposition of a discriminatory vaccine surcharge in violation of ERISA, 29 U.S.C. § 1182; (3) failure to notify of a reasonable alternative standard for avoiding the tobacco surcharge in violation of 29 U.S.C. § 1182 and 29 C.F.R. § 2590.702; (4) failure to notify of a reasonable alternative standard for avoiding the vaccine surcharge in violation of 29 U.S.C. § 1182 and 29 C.F.R. § 2590.702; and, (5) breach of fiduciary duty in violation of ERISA, §§ 404 and 406, 29 U.S.C. §§ 1104 and 1106. (R. 1). Progressive has moved to dismiss the Complaint under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim, as well as under Federal Rule of Civil Procedure (12)(b)(1) for la ck of subject-matter jurisdiction. (R. 13). The latter argument suggests Plaintiffs have not plausibly alleged an injury in fact and lack standing. (R. 13, PageID# 79-85).1 Plaintiffs have opposed said motion (R. 14), and Defendant has filed a reply supporting its motion. (R. 16). For the following reasons, the Court GRANTS Defendant Progressive’s Motion to Dismiss this case for failure to state a claim. I. Background A. Wellness Programs Under ERISA Under ERISA, “[a] group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.” 29 U.S.C. § 1182(b)(1). Nevertheless, the very next subsection of ERISA clarifies that:

Nothing in paragraph (1) shall be construed--

***

(B) to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

29 U.S.C.A. § 1182(b)(2). Further, the Affordable Care Act (“ACA”) amended ERISA, making certain provisions of the Public Health Service Act (“PHSA”) applicable to wellness programs. See

1 Defendant’s motion attaches “The Progressive Health Life And Disability Benefits Plan: Summary Plan Description” (“SPD”) referenced in the Complaint. (R. 13-1). 29 U.S.C.A. § 1185d(a) (“the provisions of part A … of the Public Health Service Act (as amended by the Patient Protection and Affordable Care Act) shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subpart….”) These programs are referred to in the statute as “wellness programs.” 42 U.S.C. § 300gg-4(j). Furthermore, the absence of a surcharge is expressly contemplated as a possible “reward” under the statute. 42 U.S.C. § 300gg-4(j)(3)(A) (“A reward may be in the form of a discount or rebate of a premium or contribution, a waiver of all or part of a cost-sharing mechanism (such as deductibles, copayments, or coinsurance), the absence of a surcharge, or the value of a benefit that would otherwise not be provided under the plan.”) (emphasis added). In 2013, the Department of Labor (“DOL”) incorporated these requirements into its regulations for non-discriminatory wellness programs. Incentives for Nondiscriminatory Wellness Programs in Group Health Plans, 78 Fed. Reg. 33158, 33181–86 (June 3, 2013) (codified at 29 C.F.R. § 2590.702). In issuing these revised regulations, the DOL specified its intent that “every individual participating in [a wellness] program should be able to receive the full amount of any reward or incentive, regardless of any health factor.” Id. at 33160.

Under the applicable regulatory scheme, outcome-based wellness programs, such as tobacco cessation programs, must satisfy five conditions. First, participants must receive at least one opportunity per year to qualify for the reward. 29 C.F.R. § 2590.702(f)(4)(i). Second, the reward must not exceed a specified percentage of the “cost of employee-only coverage under the plan.” Id. § 2590.702(f)(4)(ii); see id. § 2590.702(f)(5) (defining the relevant percentage for tobacco-reduction programs as fifty percent). Third, the program “must be reasonably designed to promote health or prevent disease.” Id. § 2590.702(f)(4)(iii). This provision requires that a program have a “reasonable chance of improving the health of, or preventing disease in, participating individuals,” not be “overly burdensome” and not act as “subterfuge for discriminating based on a health factor.” Id.

Fourth, “[t]he full reward ... must be available to all similarly situated individuals,” requiring a “reasonable alternative standard ... for any individual who does not meet the initial standard.” Id. § 2590.702(f)(4)(iv)(A). In determining whether a plan furnishes a reasonable alternative standard, “[a]ll the facts and circumstances are taken into account,” including the time commitment and cost for program completion. Id. § 2590.702(f)(4)(iv)(C). The plan must also accommodate the recommendations of an individual’s personal physician if that physician deems a plan standard “not medically appropriate for that individual.” Id. Lastly, the plan must “disclose in all plan materials describing the terms of an outcome-based wellness program ...

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