app.rippling.com Open in urlscan Pro
2606:4700:4400::ac40:91f6  Public Scan

Submitted URL: https://www.previewbenefits.bonsai.llc/
Effective URL: https://app.rippling.com/benefits/preview/xgrlgoqmvlm5exee
Submission: On June 20 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

<form aria-labelledby="form-1-header">
  <div data-testid="formHeader" class="css-1cdv3h8-Title e1jg2hff0">
    <div class="css-b0a3g-Container egjd97o4">
      <div class="css-l8sy08-Content egjd97o2">
        <div id="form-1-header" class="css-ov6af5-TitleCaption egjd97o0">
          <h5 class="css-1hgxeni-H5Element e1nwqs9d0">Bonsai Data Solutions, LLC's Benefits</h5>
          <h6 class="css-s6g6c3-SubTitleElement e1d0dggt0">Welcome to Rippling. We help Bonsai Data Solutions, LLC manage their benefits and they would like to give you a preview of the benefits they offer. In order to accurately estimate your costs,
            we need to get a little information from you.</h6>
        </div>
      </div>
    </div>
  </div>
  <div class="css-kex8gp-FieldWrapper ehdc4f55" data-testid="field">
    <div class="css-1s7i3ef-LabelContainer ehdc4f52"><span id="field-2-label" class="css-na3ulo-Label ehdc4f53">What is your expected start date?</span><span class="css-119gcrx-Asterisk ehdc4f54">*</span></div>
    <div class="css-fr5na3-InputContainer ehdc4f50">
      <div data-testid="startDate" class="css-1a9r5r6-DateContainer e1ksjg081">
        <div>
          <div aria-labelledby="field-2-label" id="field-2" data-title="Date" class="css-r21nls-StyledBaseInputContainer-DateInputContainer e1rwjy10">
            <div class="css-iyuz3-LeftSection e1rwjy12"><span class="css-12tha2k-DateIconContainer e1ksjg080"><span data-icon="CALENDAR_OUTLINE" color="#8C8888" type="&quot;\e970&quot;" aria-hidden="true"
                  class="css-1qavt9e-StyledIcon e15vvzxy0"></span></span>
              <div data-testid="month" class="css-inzusp-StyledBaseInputContainer-InputContainer-serializedCss e1j1vcgk5"><input data-input="month" data-testid="input-month" id="field-2-month" aria-required="true" autocomplete="off" maxlength="2"
                  placeholder="MM" aria-label="month" role="spinbutton" aria-valuemax="12" aria-valuemin="1" name="pNHEzY_yK" class="css-r9x0c7-Input e1j1vcgk0" value=""></div>
              <p class="css-nonk2z-Body1Element-Separator e1rwjy11">/</p>
              <div data-testid="day" class="css-1poosmd-StyledBaseInputContainer-InputContainer-serializedCss e1j1vcgk5"><input data-input="day" data-testid="input-day" id="field-2-day" aria-required="true" autocomplete="off" maxlength="2"
                  placeholder="DD" aria-label="day" role="spinbutton" aria-valuemax="31" aria-valuemin="1" name="d0yUs830du" class="css-r9x0c7-Input e1j1vcgk0" value=""></div>
              <p class="css-nonk2z-Body1Element-Separator e1rwjy11">/</p>
              <div data-testid="year" class="css-1xd7crq-StyledBaseInputContainer-InputContainer-serializedCss e1j1vcgk5"><input data-input="year" data-testid="input-year" id="field-2-year" aria-required="true" autocomplete="off" maxlength="4"
                  placeholder="YYYY" aria-label="year" role="spinbutton" aria-valuemax="2100" aria-valuemin="1900" name="rIi7wZHVlq" class="css-r9x0c7-Input e1j1vcgk0" value=""></div>
            </div>
            <div class="css-49vmp6-RightSection e1rwjy13"></div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div data-testid="form-group-header" class="css-1q55c05-HeaderWrapper e4ozahd0">
    <h6 class="css-srlbs2-H6Element-TitleContainer e4ozahd3"><span class="css-1cdv3h8-Title e4ozahd4">Where will you live while working for Bonsai Data Solutions, LLC?</span></h6>
  </div>
  <div class="css-kex8gp-FieldWrapper ehdc4f55" data-testid="field">
    <div class="css-1s7i3ef-LabelContainer ehdc4f52"><span id="field-7-label" class="css-na3ulo-Label ehdc4f53">US State</span><span class="css-119gcrx-Asterisk ehdc4f54">*</span></div>
    <div class="css-fr5na3-InputContainer ehdc4f50">
      <div data-testid="stateCode" class="css-1qb00t1-StyledBaseInputContainer-SelectContainer e1gp2ih30">
        <div>
          <div data-testid="select-controller" class="css-16h6m91-Container eyvyh547">
            <div class="css-292i0l-LeftSection eyvyh545">
              <div class="css-1xmq06x-DefaultWrapper eyvyh549">
                <div data-testid="select-search-input" class="css-1wlnq15-StyledBaseInputContainer-InputContainer-serializedCss e1j1vcgk5"><input data-input="select-search-input" data-testid="input-select-search-input" id="field-7"
                    aria-required="true" autocomplete="auto-complete-off" placeholder="Search" aria-label="Search" aria-labelledby="field-7-label" role="combobox" aria-autocomplete="list" aria-haspopup="listbox" aria-expanded="false"
                    name="ifeAD4tBNx" class="css-r9x0c7-Input e1j1vcgk0" value=""></div>
              </div>
            </div>
            <div class="css-hvqk95-RightSection eyvyh544"><span data-icon="CHEVRON_DOWN" color="#000000" type="&quot;\e90c&quot;" size="22" aria-hidden="true" class="css-1hjtmfz-StyledIcon e15vvzxy0"></span></div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="css-kex8gp-FieldWrapper ehdc4f55" data-testid="field">
    <div class="css-1s7i3ef-LabelContainer ehdc4f52"><span id="field-11-label" class="css-na3ulo-Label ehdc4f53">Zip Code</span><span class="css-119gcrx-Asterisk ehdc4f54">*</span></div>
    <div class="css-fr5na3-InputContainer ehdc4f50">
      <div data-testid="zipCode" class="css-snfi3k-StyledBaseInputContainer-InputContainer e1j1vcgk5"><input data-input="zipCode" data-testid="input-zipCode" id="field-11" aria-required="true" autocomplete="off" maxlength="5" placeholder="Zip Code"
          aria-labelledby="field-11-label" name="U2B0ltmuve" class="css-r9x0c7-Input e1j1vcgk0" value=""></div>
    </div>
  </div>
  <div data-testid="form-group-header" class="css-1q55c05-HeaderWrapper e4ozahd0">
    <h6 class="css-srlbs2-H6Element-TitleContainer e4ozahd3"><span class="css-1cdv3h8-Title e4ozahd4">Which family members will be enrolled in your benefits coverage?</span></h6>
  </div>
  <div class="css-kex8gp-FieldWrapper ehdc4f55" data-testid="field">
    <div class="css-fr5na3-InputContainer ehdc4f50">
      <section class="Grid" id="grid-14" aria-labelledby="grid-14-header" style="height: 293px;">
        <div class="Grid__content">
          <div class="Grid__header has-border-top">
            <div class="css-19midj6 effiv9z0">
              <div class="css-1ri6hs4 effiv9z1">
                <div class="css-1vv9zr effiv9z2">
                  <div id="grid-14-header" class="css-1dtnjt5 effiv9z3">
                    <p class="css-3384rw-Body1Element etfndfz0"><span class="css-17pa8l2 effiv9z4">Showing 1 of 1</span></p>
                  </div>
                </div>
                <div class="css-1y2041b effiv9z6">
                  <div data-testid="showInvalidRows" role="switch" tabindex="0" aria-checked="false" class="css-kj10h7-LabelContainer essrqqm2"><span class="css-1uo28g-Icon essrqqm0"><input type="checkbox"
                        class="css-fu557f-HiddenInput e1a3qpoh2"></span><span class="css-1wbxx8-Label essrqqm1">Only show errors</span></div>
                </div>
              </div>
            </div>
          </div>
          <div data-grid-table-container="true" class="Grid__table">
            <div class="Grid__scrollBase">
              <div style="height: 122px; overflow: visible; width: 518px;">
                <div style="height: 64px; position: relative; width: 518px;">
                  <div class="TopRightGrid_ScrollWrapper" style="left: 0px; overflow: hidden; position: absolute; top: 0px; height: 64px; width: 518px;">
                    <div data-role="grid" aria-label="Table with 1 rows and 3 columns" class="ReactVirtualized__Grid Grid__TopRightGrid" role="group"
                      style="box-sizing: border-box; direction: ltr; height: 64px; position: absolute; width: 518px; will-change: transform; overflow: auto hidden; left: 0px; top: 0px;">
                      <div class="ReactVirtualized__Grid__innerScrollContainer" role="rowgroup" style="width: 518px; height: 64px; max-width: 518px; max-height: 64px; overflow: hidden; position: relative;">
                        <div role="columnheader" data-column-header="true" data-row="-1" data-visual-row="-1" data-col="0" data-testid="Header" class="css-4sfadc ed5nkeg0" style="height: 64px; left: 0px; position: absolute; top: 0px; width: 231px;">
                          <div class="css-19tmeli ed5nkeg2">
                            <p id="column-header-15-title" required="" data-testid="Header-title" class="lineClamp css-1aqyidp-Body2Element ed5nkeg3">Relationship</p>
                            <div data-testid="grid-column-filters" class="css-16182zz e3p4lkh7"><span data-testid="sort-order" id="column-header-15-title_sort_order" role="button" tabindex="0" aria-label="Sort descending"
                                aria-labelledby="column-header-15-title_sort_order column-header-15-title" data-asc-active="true" class="css-1tdy2v5 e3p4lkh5"><span data-icon="DROPDOWN_ARROW_UP_FILLED" color="#4A6BA6" type="&quot;\e909&quot;"
                                  size="22" aria-hidden="true" class="css-ui3ng4-StyledIcon e15vvzxy0"></span><span data-icon="DROPDOWN_ARROW_DOWN_FILLED" color="#939393" type="&quot;\e906&quot;" size="22" aria-hidden="true"
                                  class="css-6n87v4-StyledIcon e15vvzxy0"></span></span></div>
                          </div>
                        </div>
                        <div role="columnheader" data-column-header="true" data-row="-1" data-visual-row="-1" data-col="1" data-testid="Header" class="css-4sfadc ed5nkeg0"
                          style="height: 64px; left: 231px; position: absolute; top: 0px; width: 181px;">
                          <div class="css-19tmeli ed5nkeg2">
                            <p id="column-header-17-title" required="" data-testid="Header-title" class="lineClamp css-1aqyidp-Body2Element ed5nkeg3">Date of Birth</p>
                            <div data-testid="grid-column-filters" class="css-16182zz e3p4lkh7"><span data-testid="sort-order" id="column-header-17-title_sort_order" role="button" tabindex="0" aria-label="Sort ascending"
                                aria-labelledby="column-header-17-title_sort_order column-header-17-title" class="css-1tdy2v5 e3p4lkh5"><span data-icon="DROPDOWN_ARROW_UP_FILLED" color="#939393" type="&quot;\e909&quot;" size="22" aria-hidden="true"
                                  class="css-1ucw0pf-StyledIcon e15vvzxy0"></span><span data-icon="DROPDOWN_ARROW_DOWN_FILLED" color="#939393" type="&quot;\e906&quot;" size="22" aria-hidden="true"
                                  class="css-6n87v4-StyledIcon e15vvzxy0"></span></span></div>
                          </div>
                        </div>
                        <div role="columnheader" data-column-header="true" data-row="-1" data-visual-row="-1" data-col="2" data-testid="Header" class="css-1ejw06q ed5nkeg0"
                          style="height: 64px; left: 412px; position: absolute; top: 0px; width: 106px;">
                          <div class="css-19tmeli ed5nkeg2">
                            <p id="column-header-19-title" data-testid="Header-title" class="lineClamp css-1ce19lh-Body2Element ed5nkeg3"></p>
                          </div>
                        </div>
                      </div>
                    </div>
                  </div>
                </div>
                <div style="height: 58px; overflow: visible; position: relative; width: 518px;">
                  <div data-role="grid" aria-label="Table with 1 rows and 3 columns" class="ReactVirtualized__Grid Grid__BottomRightGrid" role="group" tabindex="0"
                    style="box-sizing: border-box; direction: ltr; height: 58px; position: absolute; width: 518px; will-change: transform; overflow: hidden; left: 0px;">
                    <div class="ReactVirtualized__Grid__innerScrollContainer" role="rowgroup" style="width: 518px; height: 56px; max-width: 518px; max-height: 56px; overflow: hidden; position: relative;">
                      <div tabindex="-1" class="Cell Cell--editable Cell--editable-disabled Cell--left SelectCell" data-row="0" data-col="0" data-visual-row="0" aria-rowindex="1" aria-colindex="1" role="gridcell"
                        style="height: 56px; left: 0px; position: absolute; top: 0px; width: 231px; border-bottom-color: transparent;"><span class="truncate SelectCell__content">You</span></div>
                      <div tabindex="-1" class="Cell Cell--editable Cell--left DateCell" data-row="0" data-col="1" data-visual-row="0" aria-rowindex="1" aria-colindex="2" role="gridcell"
                        style="height: 56px; left: 231px; position: absolute; top: 0px; width: 181px; border-bottom-color: transparent;"><span class="truncate DateCell__content"></span><span class="Cell__icons"><span data-icon="INFO_CIRCLE_FILL"
                            color="#C3402C" type="&quot;\e9f6&quot;" size="12" aria-label="Invalid" tabindex="0" role="note" class=" css-12ujy5-StyledIcon e15vvzxy0"></span></span></div>
                      <div tabindex="-1" class="Cell Cell--noRightBorder Cell--left" data-row="0" data-col="2" data-visual-row="0" aria-rowindex="1" aria-colindex="3" role="gridcell"
                        style="height: 56px; left: 412px; position: absolute; top: 0px; width: 106px; border-bottom-color: transparent; border-right-color: transparent; display: block; line-height: 56px;"></div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="Grid__canScroll"></div>
            </div>
          </div>
          <div class="Grid__footer has-border-bottom">
            <div class="Grid__addBtn"><button data-disabled="false" data-testid="Add New Dependent" id="gridAddRow" type="button" class="css-2ox0a4-Container-serializedCss eeddhkb1"><span class="css-1b5p2my-Content eeddhkb0"><span
                    data-icon="ADD_CIRCLE_OUTLINE" type="&quot;\e9c6&quot;" size="24" aria-hidden="true" class="css-1wgxsz8-StyledIcon e15vvzxy0"></span><span>Add New Dependent</span></span></button></div>
          </div>
        </div>
      </section><span id="field-13-helptext" class="css-1dpo62n-StyledMessage evjw4s10">Enter all details for members</span>
    </div>
    <div data-testid="screen-reader-only" role="alert" aria-labelledby="field-13-helptext" class="css-bb7r4x-Container e1vad6fq0"></div>
  </div>
  <div class="css-j66fys-Footer e1jg2hff1">
    <div class="css-1xw9f6o-Container e1j6mgwy1">
      <div class="css-lbvl5l-ButtonContainer e1jg2hff3"><button data-disabled="true" data-testid="See estimate" type="submit" class="css-w47k9n-Container-serializedCss eeddhkb1" aria-disabled="true"><span
            class="css-1b5p2my-Content eeddhkb0"><span>See estimate</span></span></button></div>
    </div>
  </div>
</form>

Text Content

 

US

BONSAI DATA SOLUTIONS, LLC'S BENEFITS

WELCOME TO RIPPLING. WE HELP BONSAI DATA SOLUTIONS, LLC MANAGE THEIR BENEFITS
AND THEY WOULD LIKE TO GIVE YOU A PREVIEW OF THE BENEFITS THEY OFFER. IN ORDER
TO ACCURATELY ESTIMATE YOUR COSTS, WE NEED TO GET A LITTLE INFORMATION FROM YOU.

What is your expected start date?*

/



/




WHERE WILL YOU LIVE WHILE WORKING FOR BONSAI DATA SOLUTIONS, LLC?

US State*

Zip Code*


WHICH FAMILY MEMBERS WILL BE ENROLLED IN YOUR BENEFITS COVERAGE?

Showing 1 of 1

Only show errors

Relationship



Date of Birth





You



Add New Dependent
Enter all details for members

See estimate