www.blueprintportal.com
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urlscan Pro
170.40.177.106
Public Scan
URL:
https://www.blueprintportal.com/register
Submission: On January 05 via api from US — Scanned from US
Submission: On January 05 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
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_ngcontent-obc-c102="" class="sc-ion-label-md-h sc-ion-label-md-s md hydrated"><strong _ngcontent-obc-c102="">Sign up using:</strong></ion-label><ion-radio-group _ngcontent-obc-c102="" formcontrolname="type"
class="ng-untouched ng-pristine ng-valid ion-untouched ion-pristine ion-valid md hydrated" role="radiogroup"><app-radio-button _ngcontent-obc-c102="" _nghost-obc-c98=""><ion-item _ngcontent-obc-c98=""
class="item-has-start-slot item-radio-checked item md item-lines-default item-fill-none in-list ion-activatable ion-focusable hydrated item-label" role="listitem"><ion-label _ngcontent-obc-c98=""
class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md hydrated" id="ion-rb-0-lbl" aria-hidden="true">Member ID Card</ion-label><ion-radio _ngcontent-obc-c98="" slot="start" aria-checked="true" aria-labelledby="ion-rb-0-lbl"
role="radio" tabindex="0" class="ion-color ion-color-primary md in-item interactive radio-checked hydrated" color="primary"></ion-radio></ion-item></app-radio-button><app-radio-button _ngcontent-obc-c102="" _nghost-obc-c98=""><ion-item
_ngcontent-obc-c98="" class="item-has-start-slot item md item-lines-default item-fill-none in-list ion-activatable ion-focusable hydrated item-label" role="listitem"><ion-label _ngcontent-obc-c98=""
class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md hydrated" id="ion-rb-1-lbl" aria-hidden="true">Social Security</ion-label><ion-radio _ngcontent-obc-c98="" slot="start" aria-checked="false" aria-labelledby="ion-rb-1-lbl"
role="radio" tabindex="-1" class="ion-color ion-color-primary md in-item interactive hydrated" color="primary"></ion-radio></ion-item></app-radio-button><app-radio-button _ngcontent-obc-c102="" _nghost-obc-c98=""><ion-item
_ngcontent-obc-c98="" class="item-has-start-slot item md item-lines-default item-fill-none in-list ion-activatable ion-focusable hydrated item-label" role="listitem"><ion-label _ngcontent-obc-c98=""
class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md hydrated" id="ion-rb-2-lbl" aria-hidden="true">MBI Number (Medicare Plans Only)</ion-label><ion-radio _ngcontent-obc-c98="" slot="start" aria-checked="false"
aria-labelledby="ion-rb-2-lbl" role="radio" tabindex="-1" class="ion-color ion-color-primary md in-item interactive hydrated" color="primary"></ion-radio></ion-item></app-radio-button><input type="hidden" class="aux-input" name="ion-rg-0"
value="memberId"></ion-radio-group></ion-list><!----><ion-note _ngcontent-obc-c102="" class="md hydrated">Enter information exactly as it appears on your ID Card <img _ngcontent-obc-c102="" alt=""
src="assets/images/member-id.png"></ion-note><!----><app-input-field _ngcontent-obc-c102="" _nghost-obc-c97=""><ion-item _ngcontent-obc-c97=""
class="ion-untouched ion-pristine ion-invalid item-interactive item-input item md item-lines-default item-fill-none hydrated item-label item-label-stacked"><ion-label _ngcontent-obc-c97="" position="stacked"
class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md label-stacked hydrated" id="ion-input-4-lbl">Member ID Number *</ion-label><ion-input _ngcontent-obc-c97="" appinputattributesenable=""
class="ng-untouched ng-pristine ng-invalid ion-untouched ion-pristine ion-invalid sc-ion-input-md-h sc-ion-input-md-s md hydrated"><input class="native-input sc-ion-input-md" aria-labelledby="ion-input-4-lbl" autocapitalize="off"
autocomplete="off" autocorrect="off" name="ion-input-4" placeholder="" spellcheck="false" type="text" aria-required="true"></ion-input><!----></ion-item><!----></app-input-field><!----><!----><!----><!----><app-input-field
_ngcontent-obc-c102="" _nghost-obc-c97=""><ion-item _ngcontent-obc-c97=""
class="ion-untouched ion-pristine ion-invalid item-interactive item-input item-has-placeholder item md item-lines-default item-fill-none hydrated item-label item-label-stacked"><ion-label _ngcontent-obc-c97="" position="stacked"
class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md label-stacked hydrated" id="ion-input-0-lbl">First Name *</ion-label><ion-input _ngcontent-obc-c97="" appinputattributesenable=""
class="ng-untouched ng-pristine ng-invalid ion-untouched ion-pristine ion-invalid sc-ion-input-md-h sc-ion-input-md-s md hydrated"><input class="native-input sc-ion-input-md" aria-labelledby="ion-input-0-lbl" autocapitalize="off"
autocomplete="off" autocorrect="off" name="ion-input-0" placeholder="first" spellcheck="false" type="text" aria-required="true"></ion-input><!----></ion-item><!----></app-input-field><app-input-field _ngcontent-obc-c102=""
_nghost-obc-c97=""><ion-item _ngcontent-obc-c97="" class="ion-untouched ion-pristine ion-valid item-interactive item-input item-has-placeholder item md item-lines-default item-fill-none hydrated item-label item-label-stacked"><ion-label
_ngcontent-obc-c97="" position="stacked" class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md label-stacked hydrated" id="ion-input-1-lbl">Middle Name</ion-label><ion-input _ngcontent-obc-c97="" appinputattributesenable=""
class="ng-untouched ng-pristine ng-valid ion-untouched ion-pristine ion-valid sc-ion-input-md-h sc-ion-input-md-s md hydrated"><input class="native-input sc-ion-input-md" aria-labelledby="ion-input-1-lbl" autocapitalize="off"
autocomplete="off" autocorrect="off" name="ion-input-1" placeholder="middle" spellcheck="false" type="text" aria-required="false"></ion-input><!----></ion-item><!----></app-input-field><app-input-field _ngcontent-obc-c102=""
_nghost-obc-c97=""><ion-item _ngcontent-obc-c97="" class="ion-untouched ion-pristine ion-invalid item-interactive item-input item-has-placeholder item md item-lines-default item-fill-none hydrated item-label item-label-stacked"><ion-label
_ngcontent-obc-c97="" position="stacked" class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md label-stacked hydrated" id="ion-input-2-lbl">Last Name *</ion-label><ion-input _ngcontent-obc-c97="" appinputattributesenable=""
class="ng-untouched ng-pristine ng-invalid ion-untouched ion-pristine ion-invalid sc-ion-input-md-h sc-ion-input-md-s md hydrated"><input class="native-input sc-ion-input-md" aria-labelledby="ion-input-2-lbl" autocapitalize="off"
autocomplete="off" autocorrect="off" name="ion-input-2" placeholder="last" spellcheck="false" type="text" aria-required="true"></ion-input><!----></ion-item><!----></app-input-field><app-input-field _ngcontent-obc-c102=""
_nghost-obc-c97=""><ion-item _ngcontent-obc-c97="" class="ion-untouched ion-pristine ion-invalid item-interactive item-input item md item-lines-default item-fill-none hydrated item-label item-label-stacked"><ion-label _ngcontent-obc-c97=""
position="stacked" class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md label-stacked hydrated" id="ion-input-3-lbl">Date of Birth *</ion-label><ion-input _ngcontent-obc-c97="" appinputattributesenable=""
class="ng-untouched ng-pristine ng-invalid ion-untouched ion-pristine ion-invalid sc-ion-input-md-h sc-ion-input-md-s md hydrated"><input class="native-input sc-ion-input-md" aria-labelledby="ion-input-3-lbl" autocapitalize="off"
autocomplete="off" autocorrect="off" max="2024-01-05" name="ion-input-3" placeholder="" spellcheck="false" type="date" aria-required="true"></ion-input><!----></ion-item><!----></app-input-field><!----><ion-list _ngcontent-obc-c102=""
lines="none" mode="md" class="ion-margin-top md list-md list-lines-none list-md-lines-none hydrated" role="list"><ion-label _ngcontent-obc-c102="" class="sc-ion-label-md-h sc-ion-label-md-s md hydrated"><strong
_ngcontent-obc-c102="">Relationship</strong></ion-label><ion-radio-group _ngcontent-obc-c102="" formcontrolname="registeringUserType" class="ng-untouched ng-pristine ng-valid ion-untouched ion-pristine ion-valid md hydrated"
role="radiogroup"><app-radio-button _ngcontent-obc-c102="" _nghost-obc-c98=""><ion-item _ngcontent-obc-c98=""
class="item-has-start-slot item-radio-checked item md item-lines-default item-fill-none in-list ion-activatable ion-focusable hydrated item-label" role="listitem"><ion-label _ngcontent-obc-c98=""
class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md hydrated" id="ion-rb-3-lbl" aria-hidden="true">I am the member</ion-label><ion-radio _ngcontent-obc-c98="" slot="start" aria-checked="true" aria-labelledby="ion-rb-3-lbl"
role="radio" tabindex="0" class="ion-color ion-color-primary md in-item interactive radio-checked hydrated" color="primary"></ion-radio></ion-item></app-radio-button><app-radio-button _ngcontent-obc-c102="" _nghost-obc-c98=""><ion-item
_ngcontent-obc-c98="" class="item-has-start-slot item md item-lines-default item-fill-none in-list ion-activatable ion-focusable hydrated item-label" role="listitem"><ion-label _ngcontent-obc-c98=""
class="ion-text-wrap sc-ion-label-md-h sc-ion-label-md-s md hydrated" id="ion-rb-4-lbl" aria-hidden="true">I am the legal guardian of the member</ion-label><ion-radio _ngcontent-obc-c98="" slot="start" aria-checked="false"
aria-labelledby="ion-rb-4-lbl" role="radio" tabindex="-1" class="ion-color ion-color-primary md in-item interactive hydrated" color="primary"></ion-radio></ion-item></app-radio-button><input type="hidden" class="aux-input" name="ion-rg-1"
value="member"></ion-radio-group></ion-list><!----><!----><!----><!----><!----></form>Text Content
STEP 1 OF 4 VERIFY MEMBER INFORMATION Help us find your account. Sign up using:Member ID CardSocial SecurityMBI Number (Medicare Plans Only)Enter information exactly as it appears on your ID Card Member ID Number *First Name *Middle NameLast Name *Date of Birth *RelationshipI am the memberI am the legal guardian of the member CancelContinue