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Submitted URL: https://mybam.bcbsmt.com/ba15a367-4e56-4523-baee-b214d87926d8
Effective URL: https://members.hcsc.net/wps/portal/bam
Submission: On September 26 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST 

<form id="resetPolicyfrm" method="post">
  <input type="hidden" name="reset" id="reset" data-di-id="#reset">
  <input type="hidden" name="index" id="index" data-di-id="#index">
  <input type="hidden" name="grpNbr" id="grpNbr" data-di-id="#grpNbr">
  <input type="hidden" name="subId" id="subId" data-di-id="#subId">
  <input type="hidden" name="dateOfBirth" id="dateOfBirth" data-di-id="#dateOfBirth">
  <input type="hidden" name="fstName" id="fstName" data-di-id="#fstName">
  <input type="hidden" name="lstName" id="lstName" data-di-id="#lstName">
  <input type="hidden" name="corpEntCd" id="corpEntCd" data-di-id="#corpEntCd">
  <input type="hidden" name="accountNumber" id="accountNumber" data-di-id="#accountNumber">
  <input type="hidden" name="accountSource" id="accountSource" data-di-id="#accountSource">
  <input type="hidden" name="houseHoldId" id="houseHoldId" data-di-id="#houseHoldId">
  <input type="hidden" name="effDate" id="effDate" data-di-id="#effDate">
  <input type="hidden" name="canDate" id="canDate" data-di-id="#canDate">
  <input type="hidden" name="memberNumber" id="memberNumber" data-di-id="#memberNumber">
  <input type="hidden" name="coverageType" id="coverageType" data-di-id="#coverageType">
  <div class="modal modal-wide-orange" id="view-my-plans" style="display: none; left: 558.5px; position: fixed;">
  </div>
</form>

Text Content

 
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