claims.healthplusplan.ca Open in urlscan Pro
205.204.80.231  Public Scan

Form analysis
1 forms found in the DOM

POST https://claims.healthplusplan.ca/login

<form class="ui form" role="form" method="POST" action="https://claims.healthplusplan.ca/login">
  <input type="hidden" name="_token" value="PiFhqiZKiLVBaMXWw21KueGwcSXZOGW8j61Dv8d9">
  <div class="field">
    <label for="email" class="screen-reader-text">E-Mail Address</label>
    <input id="email" type="email" class="form-control" name="email" placeholder="E-Mail Address" value="" required="" autofocus="">
  </div>
  <div class="field">
    <label for="password" class="screen-reader-text">Password</label>
    <input id="password" type="password" class="form-control" name="password" placeholder="Password" required="">
  </div>
  <div class="field">
    <div class="ui checkbox">
      <input type="checkbox" class="hidden" id="remember" name="remember">
      <label for="remember">Remember Me</label>
    </div>
  </div>
  <div class="field">
    <button type="submit" class="ui primary button">Login</button>
    <a href="https://claims.healthplusplan.ca/password/reset">Forgot Your Password?</a>
  </div>
</form>

Text Content

LOGIN

E-Mail Address
Password
Remember Me
Login Forgot Your Password?





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