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5 forms found in the DOM

Name: gsearch — GET /search

<form role="search" class="gsearch" name="gsearch" method="get" action="/search">
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    <button class="btn btn-search" value="search"> Search </button>
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---

Name: gsearch — GET /search

<form role="search" class="gsearch" name="gsearch" method="get" action="/search">
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        <span class="visible-lg" style="text-transform: capitalize;">Search</span><span class="glyphicons search hidden-lg" aria-label="search button"></span></button>
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---

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        <h1 title="Sign up for updates &amp; reminders from HealthCare.gov modal window" id="modal-nams"> Sign up for updates &amp; reminders from HealthCare.gov </h1>
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      <div class="modal-body">
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          <div class="subscribe-type group">
            <p>Subscribe to get email (or text) updates with important deadline reminders, useful tips, and other information about your health insurance.</p>
            <div class="error-msg row hide" aria-hidden="true" role="alert">
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                <a class="invalid-number hide error-text-box" aria-hidden="true" onclick="document.getElementById('number-modal').focus(); return false;" href="#">Sorry, that mobile phone number is invalid.</a>
                <a class="blank-email hide error-text-box" aria-hidden="true" onclick="document.getElementById('address-modal').focus(); return false;" href="#">You need to provide either your email address or mobile phone number.</a>
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                <option value="58679">Maryland</option>
                <option value="58680">Massachusetts</option>
                <option value="58681">Michigan</option>
                <option value="58682">Minnesota</option>
                <option value="58683">Mississippi</option>
                <option value="58684">Missouri</option>
                <option value="58685">Montana</option>
                <option value="58686">Nebraska</option>
                <option value="58687">Nevada</option>
                <option value="58688">New Hampshire</option>
                <option value="58689">New Jersey</option>
                <option value="58690">New Mexico</option>
                <option value="58691">New York</option>
                <option value="58692">North Carolina</option>
                <option value="58693">North Dakota</option>
                <option value="58694">Ohio</option>
                <option value="58695">Oklahoma</option>
                <option value="58696">Oregon</option>
                <option value="58697">Pennsylvania</option>
                <option value="58698">Rhode Island</option>
                <option value="58699">South Carolina</option>
                <option value="58700">South Dakota</option>
                <option value="58701">Tennessee</option>
                <option value="58702">Texas</option>
                <option value="58703">Utah</option>
                <option value="58704">Vermont</option>
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                <option value="58710">American Samoa</option>
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              <div class="col-sm-6">
                <div class="spacer-bottom20"></div>
                <!-- Left column div on modal view -->
                <label for="address-modal">Get email updates</label>
                <!-- Email text input -->
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                <p id="invalid-email-id" class="invalid-email hide error-text" aria-hidden="true" tabindex="-1"> Sorry, that email address is invalid. </p>
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                <p id="blank-number-id" class="blank-number hide error-text" aria-hidden="true" tabindex="-1"> You need to provide either your email address or mobile phone number. </p>
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          <fieldset class="sub">
            <legend class="sr-only">What would you like to get updates about?</legend>
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                <h2 id="error-title-screen2" role="alert" tabindex="0">Your information contains <span class="errorNumber"></span> error(s):</h2>
                <a class="invalid-checkbox hide error-text-box" aria-hidden="true" role="alert" onclick="document.getElementById('check1').focus(); return false;" href="#">Please select a topic.</a>
              </div>
            </div>
            <div class="checkbox">
              <label>
                <input type="checkbox" id="check1" name="t[]" value="USCMSHIM_19">Health insurance for individuals &amp; families</label>
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            <div class="checkbox">
              <label>
                <input type="checkbox" id="check2" name="t[]" value="USCMSHIM_20">Health insurance for small businesses</label>
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            <div class="checkbox">
              <label>
                <input type="checkbox" id="check3" name="t[]" value="USCMSHIM_2">News &amp; information from the HealthCare.gov blog</label>
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          <p class="invalid-checkbox hide error-text" aria-hidden="true"> Please select a topic. </p>
        </div>
        <!--complete-->
        <div class="complete screen hidden" id="screen2">
          <p>Now that you’re signed up, we’ll send you deadline reminders, plus tips about how to get enrolled, stay enrolled, and get the most from your health insurance.</p>
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---

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  <input placeholder="Email Address" name="e" type="email" required="" id="prefix-emailInput" aria-labelledby="prefix-overlay-label" title="Email Address">
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      <option value="58665">Connecticut</option>
      <option value="58666">Delaware</option>
      <option value="58667">District of Columbia</option>
      <option value="58668">Florida</option>
      <option value="58669">Georgia</option>
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      <option value="58672">Illinois</option>
      <option value="58673">Indiana</option>
      <option value="58670">Hawaii</option>
      <option value="58674">Iowa</option>
      <option value="58675">Kansas</option>
      <option value="58676">Kentucky</option>
      <option value="58677">Louisiana</option>
      <option value="58678">Maine</option>
      <option value="58679">Maryland</option>
      <option value="58680">Massachusetts</option>
      <option value="58681">Michigan</option>
      <option value="58682">Minnesota</option>
      <option value="58683">Mississippi</option>
      <option value="58684">Missouri</option>
      <option value="58685">Montana</option>
      <option value="58686">Nebraska</option>
      <option value="58687">Nevada</option>
      <option value="58688">New Hampshire</option>
      <option value="58689">New Jersey</option>
      <option value="58690">New Mexico</option>
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      <option value="58692">North Carolina</option>
      <option value="58693">North Dakota</option>
      <option value="58694">Ohio</option>
      <option value="58695">Oklahoma</option>
      <option value="58696">Oregon</option>
      <option value="58697">Pennsylvania</option>
      <option value="58698">Rhode Island</option>
      <option value="58699">South Carolina</option>
      <option value="58700">South Dakota</option>
      <option value="58701">Tennessee</option>
      <option value="58702">Texas</option>
      <option value="58703">Utah</option>
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      <option value="58707">West Virginia</option>
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---

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---

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How to...

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More details if you...

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Taxes, fees, & exemptions

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HHS.gov
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Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244.
Health Insurance Marketplace® is a registered trademark of the Department of
Health and Human Services.
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 * USA.gov

--------------------------------------------------------------------------------


RESOURCES

 * About the Affordable Care Act
 * Regulatory and Policy Information
 * For Navigators, Assisters & Partners
 * For Agents & Brokers
 * For the Media
 * For Researchers
 * For States
 * Information in other languages


CONNECT WITH US

 * Questions? Call 1-800-318-2596
 * Find Local Help
 * Visit the HealthCare.gov blog

 * FacebookTwitterYouTube

All Topics | Glossary | Contact Us | Archive
Nondiscrimination / Accessibility | Privacy Policy | Privacy Settings | Linking
Policy | Using This Site | Plain Writing

--------------------------------------------------------------------------------

中文 |  Kreyòl |  Français |  Deutsch |  ગુજરાતી |  हिंदी |  Italiano |  日本語 | 
한국어 |  Polski |  Português |  Русский |  Español |  Tagalog |  tiếng việt | 
HHS.gov A federal government website managed and paid for by the U.S. Centers
for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244.
Health Insurance Marketplace® is a registered trademark of the Department of
Health and Human Services.
 * Whitehouse.gov
 * USA.gov

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