medicare.highmarkhealthplan.com Open in urlscan Pro
67.221.0.214  Public Scan

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1 forms found in the DOM

POST /roadmapn2m/CodeGate

<form class="blueBackground stage" action="/roadmapn2m/CodeGate" method="post" novalidate="novalidate">
  <h1>Welcome</h1>
  <p>If you have a Priority Code, please enter it below.</p>
  <input class="" data-val="true"
    data-val-length="The Priority Code you entered is incorrect or has already been used. Please re-enter your code in case there was an error. Your Priority Code is six characters (XXX - XXX) and is located in the letter or email we sent you."
    data-val-length-max="7"
    data-val-regex="The Priority Code you entered is incorrect or has already been used. Please re-enter your code in case there was an error. Your Priority Code is six characters (XXX - XXX) and is located in the letter or email we sent you."
    data-val-regex-pattern="([\da-zA-Z]{3})-([\da-zA-Z]{3})" id="PriorityCode" name="PriorityCode" placeholder="Priority Code" type="text" value="">
  <span id="pcalert"><span class="field-validation-valid error" data-valmsg-for="PriorityCode" data-valmsg-replace="true"></span></span>
  <p>Don't have a Priority Code? Enter your ZIP Code to get started.</p>
  <input class="" id="ZipCode" maxlength="5" name="ZipCode" placeholder="(e.g., 15211)" type="text" value="">
  <span class="field-validation-valid error" data-valmsg-for="ZipCode" data-valmsg-replace="true"></span>
  <button type="submit" id="formSubmit">
    <span>Continue <i class="fa fa-caret-right"></i></span>
  </button>
</form>

Text Content

WELCOME

If you have a Priority Code, please enter it below.

Don't have a Priority Code? Enter your ZIP Code to get started.

Continue