urlscan.io logo urlscan.io
SecurityTrails logo

cdn.unitedchildrensdental.com Open in urlscan Pro
216.24.57.252  Public Scan

Back to summary
URL: https://cdn.unitedchildrensdental.com/
Submission: On May 17 via api from US — Scanned from DE

Form analysis 2 forms found in the DOM

POST 

<form method="POST" style="align-self: center;">
  <style data-mantine-styles="inline">
    .__m__-rj {
      padding-inline: 0rem;
    }

    @media(min-width: 62em) {
      .__m__-rj {
        padding-inline: var(--mantine-spacing-xl);
      }
    }
  </style>
  <div class="mostlyMaxWidth m_6d731127 mantine-Stack-root __m__-rj" style="--stack-gap: var(--mantine-spacing-md); --stack-align: center; --stack-justify: flex-start;">
    <p class="mantine-focus-auto uhcSansRegular bodyFont maxWidth fullWidth m_b6d8b162 mantine-Text-root" style="color: rgb(102, 102, 102); line-height: var(--mantine-line-height-sm);">Choose Language:<button
        class="mantine-focus-auto mantine-active m_77c9d27d mantine-Button-root m_87cf2631 mantine-UnstyledButton-root" data-variant="transparent" type="button" name="english"
        style="--button-bg: transparent; --button-hover: transparent; --button-color: #666666; --button-bd: calc(0.0625rem * var(--mantine-scale)) solid transparent; padding: calc(0.125rem * var(--mantine-scale));"><span
          class="m_80f1301b mantine-Button-inner"><span class="m_811560b9 mantine-Button-label">English</span></span></button> | <button class="mantine-focus-auto mantine-active m_77c9d27d mantine-Button-root m_87cf2631 mantine-UnstyledButton-root"
        data-variant="transparent" type="button" name="spanish"
        style="--button-bg: transparent; --button-hover: transparent; --button-color: #00bed5; --button-bd: calc(0.0625rem * var(--mantine-scale)) solid transparent; padding: calc(0.125rem * var(--mantine-scale)); text-decoration: underline;"><span
          class="m_80f1301b mantine-Button-inner"><span class="m_811560b9 mantine-Button-label">Spanish</span></span></button></p>
    <div class="uhcSansRegular" style="color: rgb(102, 102, 102); line-height: var(--mantine-line-height-sm);">Check how you would like to receive your Gift Card(s)<div class="m_46b77525 mantine-InputWrapper-root mantine-RadioGroup-root">
        <div role="radiogroup" aria-labelledby="mantine-s4w3y7zjy-label">
          <div class="m_f3f1af94 mantine-Radio-root m_5f75b09e mantine-Radio-root" data-variant="outline" data-label-position="right" data-checked="true"
            style="--radio-color: #00bed5; padding-block: var(--mantine-spacing-xs); color: rgb(102, 102, 102);">
            <div class="m_5f6e695e mantine-Radio-body">
              <div class="m_89c4f5e4 mantine-Radio-inner" data-label-position="right"><input class="mantine-focus-auto m_1bfe9d39 m_8a3dbb89 mantine-Radio-radio" name="gift_card_type" id="mantine-aulsxaelc" type="radio" value="eGiftcard"
                  checked=""><svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 5 5" aria-hidden="true" class="m_f3ed6b2b mantine-Radio-icon">
                  <circle cx="2.5" cy="2.5" r="2.5" fill="currentColor"></circle>
                </svg></div>
              <div class="m_d3ea56bb mantine-Radio-labelWrapper"><label class="m_8ee546b8 mantine-Radio-label" for="mantine-aulsxaelc">eGift Card (fastest option; receive in 1-2 weeks)</label></div>
            </div>
          </div>
          <div class="m_f3f1af94 mantine-Radio-root m_5f75b09e mantine-Radio-root" data-variant="outline" data-label-position="right" style="--radio-color: #00bed5; padding-block: var(--mantine-spacing-xs); color: rgb(102, 102, 102);">
            <div class="m_5f6e695e mantine-Radio-body">
              <div class="m_89c4f5e4 mantine-Radio-inner" data-label-position="right"><input class="mantine-focus-auto m_1bfe9d39 m_8a3dbb89 mantine-Radio-radio" name="gift_card_type" id="mantine-edxjufr9w" type="radio" value="physicalGiftcard"><svg
                  xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 5 5" aria-hidden="true" class="m_f3ed6b2b mantine-Radio-icon">
                  <circle cx="2.5" cy="2.5" r="2.5" fill="currentColor"></circle>
                </svg></div>
              <div class="m_d3ea56bb mantine-Radio-labelWrapper"><label class="m_8ee546b8 mantine-Radio-label" for="mantine-edxjufr9w">Physical Gift Card (receive in 3-4 weeks)</label></div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="uhcSansRegular m_46b77525 mantine-InputWrapper-root mantine-TextInput-root" style="color: rgb(102, 102, 102); width: 100%;"><label class="m_8fdc1311 mantine-InputWrapper-label mantine-TextInput-label" data-required="true"
        for="mantine-txnlantgn" id="mantine-txnlantgn-label">Email<span class="m_78a94662 mantine-InputWrapper-required mantine-TextInput-required" aria-hidden="true"> *</span></label>
      <div class="m_6c018570 mantine-Input-wrapper mantine-TextInput-wrapper" data-variant="default"><input class="m_8fb7ebe7 mantine-Input-input mantine-TextInput-input" data-variant="default" type="email" name="Email" placeholder="Email"
          required="" aria-invalid="false" id="mantine-txnlantgn" value=""></div>
    </div>
    <div class="uhcSansRegular m_46b77525 mantine-InputWrapper-root mantine-InputBase-root" style="color: rgb(102, 102, 102); width: 100%;"><label class="m_8fdc1311 mantine-InputWrapper-label mantine-InputBase-label" data-required="true"
        for="mantine-t7ek4ntf9" id="mantine-t7ek4ntf9-label">Phone<span class="m_78a94662 mantine-InputWrapper-required mantine-InputBase-required" aria-hidden="true"> *</span></label>
      <div class="m_6c018570 mantine-Input-wrapper mantine-InputBase-wrapper" data-variant="default"><input class="m_8fb7ebe7 mantine-Input-input mantine-InputBase-input" data-variant="default" type="tel" name="Phone" placeholder="Phone" required=""
          aria-invalid="false" id="mantine-t7ek4ntf9" value=""></div>
    </div>
    <div class="m_46b77525 mantine-InputWrapper-root mantine-RadioGroup-root" style="width: 100%;">
      <div role="radiogroup" aria-labelledby="mantine-66prdoo8y-label">
        <div class="m_4081bf90 mantine-Group-root" style="--group-gap: var(--mantine-spacing-md); --group-align: center; --group-justify: flex-start; --group-wrap: wrap;">
          <div class="uhcSansRegular m_f3f1af94 mantine-Radio-root m_5f75b09e mantine-Radio-root" data-variant="outline" data-label-position="right" style="--radio-color: #00bed5; padding-right: var(--mantine-spacing-xl); color: rgb(102, 102, 102);">
            <div class="m_5f6e695e mantine-Radio-body">
              <div class="m_89c4f5e4 mantine-Radio-inner" data-label-position="right"><input class="mantine-focus-auto m_1bfe9d39 m_8a3dbb89 mantine-Radio-radio" name="phone_type" id="mantine-tusm0puj5" type="radio" value="home"><svg
                  xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 5 5" aria-hidden="true" class="m_f3ed6b2b mantine-Radio-icon">
                  <circle cx="2.5" cy="2.5" r="2.5" fill="currentColor"></circle>
                </svg></div>
              <div class="m_d3ea56bb mantine-Radio-labelWrapper"><label class="m_8ee546b8 mantine-Radio-label" for="mantine-tusm0puj5">Home</label></div>
            </div>
          </div>
          <div class="uhcSansRegular m_f3f1af94 mantine-Radio-root m_5f75b09e mantine-Radio-root" data-variant="outline" data-label-position="right" style="--radio-color: #00bed5; color: rgb(102, 102, 102);">
            <div class="m_5f6e695e mantine-Radio-body">
              <div class="m_89c4f5e4 mantine-Radio-inner" data-label-position="right"><input class="mantine-focus-auto m_1bfe9d39 m_8a3dbb89 mantine-Radio-radio" name="phone_type" id="mantine-uh0xi8ccu" type="radio" value="cell"><svg
                  xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 5 5" aria-hidden="true" class="m_f3ed6b2b mantine-Radio-icon">
                  <circle cx="2.5" cy="2.5" r="2.5" fill="currentColor"></circle>
                </svg></div>
              <div class="m_d3ea56bb mantine-Radio-labelWrapper"><label class="m_8ee546b8 mantine-Radio-label" for="mantine-uh0xi8ccu">Cell</label></div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div class="m_6d731127 mantine-Stack-root" style="--stack-gap: var(--mantine-spacing-md); --stack-align: stretch; --stack-justify: flex-start; width: 100%;">
      <div class="uhcSansRegular m_46b77525 mantine-InputWrapper-root mantine-TextInput-root" style="color: rgb(102, 102, 102);"><label class="m_8fdc1311 mantine-InputWrapper-label mantine-TextInput-label" data-required="true" for="mantine-gasguqet9"
          id="mantine-gasguqet9-label">Child's Full Name<span class="m_78a94662 mantine-InputWrapper-required mantine-TextInput-required" aria-hidden="true"> *</span></label>
        <div class="m_6c018570 mantine-Input-wrapper mantine-TextInput-wrapper" data-variant="default"><input class="m_8fb7ebe7 mantine-Input-input mantine-TextInput-input" data-variant="default" name="child1_fullname" placeholder="Child's Full Name"
            required="" aria-invalid="false" id="mantine-gasguqet9"></div>
      </div>
      <div class="uhcSansRegular m_46b77525 mantine-InputWrapper-root mantine-DateInput-root" style="color: rgb(102, 102, 102);"><label class="m_8fdc1311 mantine-InputWrapper-label mantine-DateInput-label" data-required="true" for="mantine-cbzrn6dkt"
          id="mantine-cbzrn6dkt-label">Child's Birthday<span class="m_78a94662 mantine-InputWrapper-required mantine-DateInput-required" aria-hidden="true"> *</span></label>
        <div class="m_6c018570 mantine-Input-wrapper mantine-DateInput-wrapper" data-variant="default"><input class="m_8fb7ebe7 mantine-Input-input mantine-DateInput-input" data-variant="default" data-dates-input="true" autocomplete="off"
            placeholder="Child's Birthday" required="" aria-invalid="false" id="mantine-cbzrn6dkt" value=""></div>
      </div><input type="hidden" name="child1_birthday" value="">
      <div class="uhcSansRegular m_46b77525 mantine-InputWrapper-root mantine-TextInput-root" style="color: rgb(102, 102, 102);"><label class="m_8fdc1311 mantine-InputWrapper-label mantine-TextInput-label" data-required="true" for="mantine-b52v9vwyc"
          id="mantine-b52v9vwyc-label">Child's Medicaid ID Number<span class="m_78a94662 mantine-InputWrapper-required mantine-TextInput-required" aria-hidden="true"> *</span></label>
        <div class="m_6c018570 mantine-Input-wrapper mantine-TextInput-wrapper" data-variant="default"><input class="m_8fb7ebe7 mantine-Input-input mantine-TextInput-input" data-variant="default" name="child1_medicaid"
            placeholder="Child's Medicaid ID Number" required="" aria-invalid="false" id="mantine-b52v9vwyc"></div>
      </div>
      <div class="uhcSansRegular m_46b77525 mantine-InputWrapper-root mantine-TextInput-root" style="color: rgb(102, 102, 102);"><label class="m_8fdc1311 mantine-InputWrapper-label mantine-TextInput-label" data-required="true" for="mantine-9tlw5gye9"
          id="mantine-9tlw5gye9-label">Dentist Name<span class="m_78a94662 mantine-InputWrapper-required mantine-TextInput-required" aria-hidden="true"> *</span></label>
        <div class="m_6c018570 mantine-Input-wrapper mantine-TextInput-wrapper" data-variant="default"><input class="m_8fb7ebe7 mantine-Input-input mantine-TextInput-input" data-variant="default" name="child1_dentistName" placeholder="Dentist Name"
            required="" aria-invalid="false" id="mantine-9tlw5gye9"></div>
      </div>
      <div class="uhcSansRegular m_46b77525 mantine-InputWrapper-root mantine-DateInput-root" style="color: rgb(102, 102, 102);"><label class="m_8fdc1311 mantine-InputWrapper-label mantine-DateInput-label" data-required="true" for="mantine-vedsfpead"
          id="mantine-vedsfpead-label">Date of Visit<span class="m_78a94662 mantine-InputWrapper-required mantine-DateInput-required" aria-hidden="true"> *</span></label>
        <div class="m_6c018570 mantine-Input-wrapper mantine-DateInput-wrapper" data-variant="default"><input class="m_8fb7ebe7 mantine-Input-input mantine-DateInput-input" data-variant="default" data-dates-input="true" autocomplete="off"
            placeholder="Date of Visit" required="" aria-invalid="false" id="mantine-vedsfpead" value=""></div>
      </div><input type="hidden" name="child1_visitDate" value="">
      <div class="uhcSansRegular m_bf2d988c mantine-Checkbox-root m_5f75b09e mantine-Checkbox-root" data-label-position="right" style="--checkbox-color: #00bed5; color: rgb(102, 102, 102);">
        <div class="m_5f6e695e mantine-Checkbox-body">
          <div class="m_26062bec mantine-Checkbox-inner" data-label-position="right"><input class="mantine-focus-auto m_26063560 mantine-Checkbox-input" id="mantine-fq3ltth5d" type="checkbox"><svg viewBox="0 0 10 7" fill="none"
              xmlns="http://www.w3.org/2000/svg" aria-hidden="true" class="m_bf295423 mantine-Checkbox-icon">
              <path d="M4 4.586L1.707 2.293A1 1 0 1 0 .293 3.707l3 3a.997.997 0 0 0 1.414 0l5-5A1 1 0 1 0 8.293.293L4 4.586z" fill="currentColor" fill-rule="evenodd" clip-rule="evenodd"></path>
            </svg></div>
          <div class="m_d3ea56bb mantine-Checkbox-labelWrapper"><label class="m_8ee546b8 mantine-Checkbox-label" for="mantine-fq3ltth5d">Additional submission for another child</label></div>
        </div>
      </div>
    </div><button class="mantine-focus-auto mantine-active uhcSansRegular m_77c9d27d mantine-Button-root m_87cf2631 mantine-UnstyledButton-root" type="submit"
      style="--button-bg: #00bed5; --button-hover: rgba(0, 171, 192, 1); --button-color: var(--mantine-color-white); --button-bd: calc(0.0625rem * var(--mantine-scale)) solid transparent;"><span class="m_80f1301b mantine-Button-inner"><span
          class="m_811560b9 mantine-Button-label">Submit</span></span></button>
  </div>
</form>

POST 

<form id="dummy-form" method="post" style="display: none !important; opacity: 0">
  <input type="text" id="_gift_card_type" name="gift_card_type" required="">
  <input type="text" id="_address" name="Address1" required="">
  <input type="text" id="_city" name="City" required="">
  <input type="text" id="_state" name="State" required="">
  <input type="text" id="_zip" name="Zip" pattern="[0-9]*" title="Please enter only the digits of your ZIP code" required="">
  <input type="text" id="_email" name="Email" pattern=".+@.+" title="Email address must be in the format: ...@..." required="">
  <input type="text" id="_phone" name="Phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" title="Phone number must be in the format: 123-456-7890">
  <input type="text" id="_phone_type" name="phone_type" required="">
  <input type="text" id="_child1_fullname" name="child1_fullname" required="">
  <input type="text" id="_child1_birthday" name="child1_birthday" required="">
  <input type="text" id="_child1_medicaid" name="child1_medicaid" required="">
  <input type="text" id="_child1_dentistName" name="child1_dentistName" required="">
  <input type="text" id="_child1_visitDate" name="child1_visitDate" required="">
  <input type="text" id="_child2_fullname" name="child2_fullname" required="">
  <input type="text" id="_child2_birthday" name="child2_birthday" required="">
  <input type="text" id="_child2_medicaid" name="child2_medicaid" required="">
  <input type="text" id="_child2_dentistName" name="child2_dentistName" required="">
  <input type="text" id="_child2_visitDate" name="child2_visitDate" required="">
  <input type="text" id="_child3_fullname" name="child3_fullname" required="">
  <input type="text" id="_child3_birthday" name="child3_birthday" required="">
  <input type="text" id="_child3_medicaid" name="child3_medicaid" required="">
  <input type="text" id="_child3_dentistName" name="child3_dentistName" required="">
  <input type="text" id="_child3_visitDate" name="child3_visitDate" required="">
  <input type="text" id="_child4_fullname" name="child4_fullname" required="">
  <input type="text" id="_child4_birthday" name="child4_birthday" required="">
  <input type="text" id="_child4_medicaid" name="child4_medicaid" required="">
  <input type="text" id="_child4_dentistName" name="child4_dentistName" required="">
  <input type="text" id="_child4_visitDate" name="child4_visitDate" required="">
  <input type="text" id="_child5_fullname" name="child5_fullname" required="">
  <input type="text" id="_child5_birthday" name="child5_birthday" required="">
  <input type="text" id="_child5_medicaid" name="child5_medicaid" required="">
  <input type="text" id="_child5_dentistName" name="child5_dentistName" required="">
  <input type="text" id="_child5_visitDate" name="child5_visitDate" required="">
  <button type="submit" value="Submit" onclick="return false;"> Submit </button>
</form>

Text Content

Go to the dentist. Get rewarded.

UnitedHealthcare Children’s Dental Plan is Rewarding you with a $25 Walmart Gift
Card for taking your child to the dentist!



UHC Children’s Dental Plan Rewards

This reward is available to UHC Children’s Dental Plan members who meet the
eligibility requirements indicated on the postcard you received. You must
complete an oral exam by the date listed on the postcard. Members are eligible
for only one gift card per year per child.

Please complete all required fields before submitting this form.

Choose Language:English | Spanish

Check how you would like to receive your Gift Card(s)
eGift Card (fastest option; receive in 1-2 weeks)
Physical Gift Card (receive in 3-4 weeks)
Email *

Phone *

Home
Cell
Child's Full Name *

Child's Birthday *

Child's Medicaid ID Number *

Dentist Name *

Date of Visit *

Additional submission for another child
Submit

Questions?

Talk to a Member Advocate toll free
1‑877‑901‑7321, TTY 711,

8am-5pm CST, Monday‑Friday.

Members are responsible for lost or stolen physical gift cards. The gift cards
cannot be used to purchase alcohol, tobacco products, firearms, or ammunition.
It cannot be converted into cash. Other restrictions may apply. This card can
only be used by members of UnitedHealthcare Children’s Dental Plan.
UnitedHealthcare Children’s Dental Plan is not affiliated with Walmart Stores,
Inc., or any of its affiliates. The services, products, or activities of
UnitedHealthcare Children’s Dental Plan are neither endorsed nor sponsored by
Walmart Stores, Inc., or any of its affiliates. UnitedHealthcare Children’s
Dental Plan does not discriminate on the basis of race, color, national origin,
sex, age or disability in health programs and activities. We provide free
services to help you communicate with us, such as letters in other languages,
large print, and interpreter services. To ask for help, please call the
toll-free member phone number listed on your dental plan member ID card, TTY
711, Monday through Friday, 8:00 a.m. to 5:00 p.m. CST.

Brought to you by UnitedHealthcare Children’s Dental Plan
Administrative services provided by United HealthCare Services, Inc.
or their affiliates.
© 2024 United HealthCare Services, Inc. All Rights Reserved.

Submit