www.bcbsks.com Open in urlscan Pro
2606:4700::6811:606  Public Scan

Form analysis
2 forms found in the DOM

GET /search

<form action="/search" method="get" id="views-exposed-form-acquia-search-page-1" accept-charset="UTF-8">
  <div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-search form-item-search form-no-label">
    <input placeholder="Search keywords" data-drupal-selector="edit-search" type="text" id="edit-search" name="search" value="" size="30" maxlength="128" class="form-text">
  </div>
  <label for="edit-keywords" class="visually-hidden">Search</label>
  <div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions"><input data-drupal-selector="edit-submit-acquia-search" type="submit" id="edit-submit-acquia-search" value="Search"
      class="button js-form-submit form-submit">
  </div>
</form>

POST /CustomerService/Employers/forms-thank-you.shtml

<form action="/CustomerService/Employers/forms-thank-you.shtml" data-action="https://secure.bcbsks.com/WebCom/Secure/email_bcbsks_enc.aspx" id="groupcontactform" method="post">
  <div class="medium-6 columns end" id="formbegin">
    <h4>Tell us about your business</h4>
    <p>All fields are required</p>
    <input name="addressSelect" type="hidden" value="___"><!-- updated via script after zip is entered --><input name="formType" type="hidden" value="bcbsks"><input name="formName" type="hidden" value="Chamber Blue of Kansas inquiry"><input
      name="Redirect" type="hidden" value="?form_submit=true"><label class="u47" for="ContactName">Contact name</label><br><input class="u47 field-valid" id="ContactName" name="Contact Name" required="" type="text"><label class="u47"
      for="ContactPhone">Phone number</label><br><input class="u47 field-valid" data-inputmask="'mask': '999-999-9999'" id="ContactPhone" inputmode="tel" name="Contact Phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" required="" type="tel"
      im-insert="true"><label class="u47" for="ContactEmail">Email address</label><br><input class="u47 field-valid" id="ContactEmail" name="E-mail Address" required="" type="email"><label class="u47" for="BusinessName">Business
      name</label><br><input class="u47 field-valid" id="BusinessName" name="Business Name" required="" type="text">
    <div class="error no-display" id="zip-entry-errors">
      <ul>
        <li class="u47 no-display" id="errZipOutsideState">Please enter a valid <!--Kansas-->
          <p> ZIP code</p>
        </li>
        <li class="u47 no-display" id="errRequireCounty">Please select your county from the dropdown</li>
        <li class="u47 no-display" id="errJoWyCounty">BCBSKS does not serve Johnson and Wyandotte counties</li>
      </ul>
    </div>
    <p> <label class="u47" for="BusinessZipCode">Business ZIP code</label><br><input autocomplete="off" class="u47 field-empty" data-inputmask="'mask': '99999'" id="BusinessZipCode" inputmode="numeric" maxlength="5" name="Zip Code" pattern="[0-9]{5}"
        required="" style="width:10em;" type="text" im-insert="true"><label class="u47" for="CountyCode">County</label><br><select class="u47" id="CountyCode" name="County Code" required="" style="width:10em;">
        <option value="">Please enter ZIP code</option>
      </select><input id="CountyValue" name="County" type="hidden" value="NONE"><label class="u47" for="BusinessSize">Number of employees</label><br><select class="u47" id="BusinessSize" name="Number of Employees" required="">
        <option value="">Please select</option>
        <option value="2-9">2-9</option>
        <option value="10 or more">10 or more</option>
      </select></p>
    <p> <label class="u47" for="ChamberMembership">Chamber of Commerce</label><br><select class="u47" id="ChamberMembership" name="Chamber of Commerce" required="">
        <option value="">Please select</option>
        <option value="Andover Area Chamber of Commerce">Andover Area Chamber of Commerce</option>
        <option value="Atchison Area Chamber of Commerce">Atchison Area Chamber of Commerce</option>
        <option value="Baldwin City Chamber of Commerce">Baldwin City Chamber of Commerce</option>
        <option value="Belleville Chamber of Commerce &amp; Main Street">Belleville Chamber of Commerce &amp; Main Street</option>
        <option value="Chanute Area Chamber of Commerce">Chanute Area Chamber of Commerce</option>
        <option value="Coffeyville Area Chamber of Commerce">Coffeyville Area Chamber of Commerce</option>
        <option value="Derby Chamber of Commerce">Derby Chamber of Commerce</option>
        <option value="Driving Dickinson County Partnership">Driving Dickinson County Partnership</option>
        <option value="El Dorado Chamber of Commerce">El Dorado Chamber of Commerce</option>
        <option value="Emporia Area Chamber of Commerce">Emporia Area Chamber of Commerce</option>
        <option value="Fort Scott Area Chamber of Commerce">Fort Scott Area Chamber of Commerce</option>
        <option value="Fredonia Area Chamber of Commerce">Fredonia Area Chamber of Commerce</option>
        <option value="Girard Area Chamber of Commerce">Girard Area Chamber of Commerce</option>
        <option value="Goddard Chamber of Commerce">Goddard Chamber of Commerce</option>
        <option value="Great Bend Chamber of Commerce">Great Bend Chamber of Commerce</option>
        <option value="Greater Topeka Partnership">Greater Topeka Partnership</option>
        <option value="Hays Chamber of Commerce">Hays Chamber of Commerce</option>
        <option value="Hesston Chamber of Commerce">Hesston Chamber of Commerce</option>
        <option value="Hutchinson / Reno County Chamber of Commerce">Hutchinson / Reno County Chamber of Commerce</option>
        <option value="Independence Chamber of Commerce">Independence Chamber of Commerce</option>
        <option value="Iola Chamber of Commerce &amp; Tourism">Iola Chamber of Commerce &amp; Tourism</option>
        <option value="Larned Area Chamber of Commerce">Larned Area Chamber of Commerce</option>
        <option value="Manhattan Area Chamber of Commerce">Manhattan Area Chamber of Commerce</option>
        <option value="McPherson Chamber of Commerce">McPherson Chamber of Commerce</option>
        <option value="Newton Area Chamber of Commerce">Newton Area Chamber of Commerce</option>
        <option value="Norton Area Chamber of Commerce">Norton Area Chamber of Commerce</option>
        <option value="Ottawa Area Chamber of Commerce">Ottawa Area Chamber of Commerce</option>
        <option value="Paola Chamber of Commerce">Paola Chamber of Commerce</option>
        <option value="Parsons Chamber of Commerce">Parsons Chamber of Commerce</option>
        <option value="Pittsburg Area Chamber of Commerce">Pittsburg Area Chamber of Commerce</option>
        <option value="Pratt Area Chamber of Commerce">Pratt Area Chamber of Commerce</option>
        <option value="Rose Hill Chamber of Commerce">Rose Hill Chamber of Commerce</option>
        <option value="Russell Area Chamber of Commerce">Russell Area Chamber of Commerce</option>
        <option value="Salina Area Chamber of Commerce">Salina Area Chamber of Commerce</option>
        <option value="The Chamber of Lawrence Kansas">The Chamber of Lawrence Kansas</option>
        <option value="Tri-County Area Chamber of Commerce">Tri-County Area Chamber of Commerce</option>
        <option value="Wellington Area Chamber of Commerce/CVB">Wellington Area Chamber of Commerce/CVB</option>
        <option value="Winfield Area Chamber of Commerce">Winfield Area Chamber of Commerce</option>
        <option value="Woodson County Chamber of Commerce">Woodson County Chamber of Commerce</option>
      </select></p>
    <div class="row">
      <div class="medium-12 columns" id="formSubmitControl">
        <input class="bcbsks-button blue-button no-print coh-link coh-style-primary-cta" id="GroupContactFormSubmit" style="width:7em;" type="submit" value="Submit"><input class="bcbsks-button white-pms144-button no-print" id="GroupContactFormReset"
          style="width:7em;" type="reset" value="Reset">
      </div>
    </div>
  </div>
</form>

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FRIEND, NEIGHBOR AND PARTNER.

WE’RE COMMITTED TO THE HEALTH OF YOUR EMPLOYEES.

CHAMBER BLUE OF KANSAS

Employer Guide Benefits Brochure



WE'RE HERE FOR YOU

We’re deeply rooted and fellow Kansans. With a dedicated account management
team, we’re here to provide you one-on-one support, training for your staff and
benefit assistance and education for your employees.

THANK YOU!

 

We have received your contact information. A sales representative will reach out
to you within two business days.

TELL US ABOUT YOUR BUSINESS

All fields are required

Contact name
Phone number
Email address
Business name

 * Please enter a valid
   
   ZIP code

 * Please select your county from the dropdown
 * BCBSKS does not serve Johnson and Wyandotte counties

Business ZIP code
County
Please enter ZIP codeNumber of employees
Please select2-910 or more

Chamber of Commerce
Please selectAndover Area Chamber of CommerceAtchison Area Chamber of
CommerceBaldwin City Chamber of CommerceBelleville Chamber of Commerce & Main
StreetChanute Area Chamber of CommerceCoffeyville Area Chamber of CommerceDerby
Chamber of CommerceDriving Dickinson County PartnershipEl Dorado Chamber of
CommerceEmporia Area Chamber of CommerceFort Scott Area Chamber of
CommerceFredonia Area Chamber of CommerceGirard Area Chamber of CommerceGoddard
Chamber of CommerceGreat Bend Chamber of CommerceGreater Topeka PartnershipHays
Chamber of CommerceHesston Chamber of CommerceHutchinson / Reno County Chamber
of CommerceIndependence Chamber of CommerceIola Chamber of Commerce &
TourismLarned Area Chamber of CommerceManhattan Area Chamber of
CommerceMcPherson Chamber of CommerceNewton Area Chamber of CommerceNorton Area
Chamber of CommerceOttawa Area Chamber of CommercePaola Chamber of
CommerceParsons Chamber of CommercePittsburg Area Chamber of CommercePratt Area
Chamber of CommerceRose Hill Chamber of CommerceRussell Area Chamber of
CommerceSalina Area Chamber of CommerceThe Chamber of Lawrence KansasTri-County
Area Chamber of CommerceWellington Area Chamber of Commerce/CVBWinfield Area
Chamber of CommerceWoodson County Chamber of Commerce





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