paymentportal.bcbsmt.com
Open in
urlscan Pro
205.172.134.131
Public Scan
Submitted URL: http://paymentportal.bcbsmt.com/
Effective URL: https://paymentportal.bcbsmt.com/
Submission: On December 01 via api from US — Scanned from DE
Effective URL: https://paymentportal.bcbsmt.com/
Submission: On December 01 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form class="fiber_form_03147559">
<div class="sc-hHEiqL jwHBxj">
<div class="sc-dIvrsQ bfLonZ"><span class="fiber_text_b06ad8fb fiber_text_Size2_b06ad8fb fiber_text_ColorBlack_b06ad8fb fiber_text_WeightBold_b06ad8fb fiber_text_StyleNormal_b06ad8fb fiber_taLeft_22dc9e15"
data-testid="memberIdLengthLabelError">Member ID Number</span><button class="fiber_iconButton_a842c970" type="button"><span class="fiber_icon_dd0fc6a6 fiber_icon_SizeInherit_dd0fc6a6 fiber_icon_ColorBlack_dd0fc6a6"><svg
xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" xml:space="preserve" fill="currentColor" role="img" aria-hidden="true" focusable="false" data-di-res-id="4646e08a-680ded07" data-di-rand="1638379848891">
<path d="M12 2C6.5 2 2 6.5 2 12s4.5 10 10 10 10-4.5 10-10S17.5 2 12 2zm0 18.5c-4.7 0-8.5-3.8-8.5-8.5S7.3 3.5 12 3.5s8.5 3.8 8.5 8.5-3.8 8.5-8.5 8.5z"></path>
<path d="M13 9.5H9.2V11h2.3v5.5H9.2V18h6v-1.5H13z"></path>
<ellipse cx="12.3" cy="7.2" rx="0.9" ry="1"></ellipse>
</svg></span><span class="fiber_iconButton__srOnly_a842c970">information</span></button></div>
<div class="sc-bkbkJK gEthbR"><img class="fiber_image_39d18bb7" alt="Member ID Card Icon" id="Image_4" data-testid="member-id-information-icon" src="https://bam-aem.hcsc.net/content/dam/hcsc/guest-payment-portal/images/member-id-icon.svg"><span
class="sc-iemWCZ hJQjnn">X</span><span class="sc-iemWCZ hJQjnn">X</span><span class="sc-iemWCZ hJQjnn">X</span>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="1" inputmode="numeric" data-testid="memberIdInput-0" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="2" inputmode="numeric" data-testid="memberIdInput-1" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="3" inputmode="numeric" data-testid="memberIdInput-2" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="4" inputmode="numeric" data-testid="memberIdInput-3" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="5" inputmode="numeric" data-testid="memberIdInput-4" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="6" inputmode="numeric" data-testid="memberIdInput-5" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="7" inputmode="numeric" data-testid="memberIdInput-6" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="8" inputmode="numeric" data-testid="memberIdInput-7" value=""></span></div>
<div class="sc-fnVZcZ fGSRBL"><span class="fiber_input_d6c55251"><input class="sc-fFSPTT datRBq memberIdInput" placeholder="9" inputmode="numeric" data-testid="memberIdInput-8" value=""></span></div>
</div>
</div>
<div class="fiber_form__field_03147559"><label for="FormField_1" class="fiber_label_30e4676d" id="FormField_1_Label"><span
class="fiber_text_b06ad8fb fiber_text_Size2_b06ad8fb fiber_text_ColorTextDark_b06ad8fb fiber_text_WeightBold_b06ad8fb fiber_text_StyleNormal_b06ad8fb fiber_taLeft_22dc9e15">Date of Birth</span></label><span class="fiber_input_d6c55251"><input
class="fiber_input__input_d6c55251" name="date-of-birth" data-testid="date-of-birth-input" type="text" placeholder="MM / YYYY" maxlength="9" inputmode="numeric" id="FormField_1" aria-labelledby="FormField_1_Label" value=""
data-di-id="#FormField_1"></span></div>
<div class="fiber_form__field_03147559"><label for="FormField_2" class="fiber_label_30e4676d" id="FormField_2_Label"><span
class="fiber_text_b06ad8fb fiber_text_Size2_b06ad8fb fiber_text_ColorTextDark_b06ad8fb fiber_text_WeightBold_b06ad8fb fiber_text_StyleNormal_b06ad8fb fiber_taLeft_22dc9e15">Billing ZIP Code</span></label><span
class="fiber_input_d6c55251"><input class="fiber_input__input_d6c55251" name="zip-code" data-testid="zip-code-input" maxlength="5" inputmode="numeric" id="FormField_2" aria-labelledby="FormField_2_Label" value=""
data-di-id="#FormField_2"></span></div><label class="fiber_checkbox_ded49b71"><input type="checkbox" data-testid="acceptTerms"><span class="fiber_checkbox__label_ded49b71 fiber_checkbox__label_Left_ded49b71"><span
class="fiber_text_b06ad8fb fiber_text_Size2_b06ad8fb fiber_text_ColorTextDark_b06ad8fb fiber_text_WeightNormal_b06ad8fb fiber_text_StyleNormal_b06ad8fb fiber_taLeft_22dc9e15 fiber_mt0_22dc9e15 fiber_mb0_22dc9e15 fiber_mr3_22dc9e15 fiber_ml3_22dc9e15"><a class="fiber_text_b06ad8fb fiber_text_Size2_b06ad8fb fiber_text_ColorTextDark_b06ad8fb fiber_text_WeightNormal_b06ad8fb fiber_text_StyleNormal_b06ad8fb fiber_taLeft_22dc9e15" data-testid="acceptTermsText">I understand and accept the </a><span
class="sc-bCwfaz hzzSzX"><a class="fiber_text_b06ad8fb fiber_text_Size2_b06ad8fb fiber_text_ColorBluePrimary_b06ad8fb fiber_text_WeightNormal_b06ad8fb fiber_text_StyleNormal_b06ad8fb fiber_taLeft_22dc9e15" data-testid="acceptTermsLink">Terms of Use and Privacy Statement.</a></span></span></span></label>
<div class="sc-dlMDgC cEdzCP"><button class="fiber_button_8d86c930 fiber_button_Size2_8d86c930 fiber_button_Primary_8d86c930 fiber_button_Block_8d86c930" disabled="" type="submit" data-testid="continue-form"><span
class="fiber_button__text_8d86c930">Continue</span></button></div>
</form>Text Content
You need to enable JavaScript to run this app. En Español Language Assistance Exit To make a payment, please fill out the policy holder's information. For the best experience, please be sure your browser is up to date. Member ID Numberinformation XXX Date of Birth Billing ZIP Code I understand and accept the Terms of Use and Privacy Statement. Continue Legal & Privacy | Non-Discrimination Notice A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2021 Health Care Service Corporation. All Rights Reserved.