members.mdlive.com
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137.116.48.19
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Submitted URL: https://links.mkt2527.com/els/v2/DymATGr8xbcb/M2RWK1VpaHBpQVErRUVqWjlPTWgrVkdOQm5WUWt4K3JuUnlEbzVhVk9sLy94bStqWE9LS0JLSkMv...
Effective URL: https://members.mdlive.com/bcbsil/new_registration?secondary_reg=true?utm_source=client_HCSC&utm_medium=email&utm_campaign=...
Submission: On November 06 via api from US — Scanned from DE
Effective URL: https://members.mdlive.com/bcbsil/new_registration?secondary_reg=true?utm_source=client_HCSC&utm_medium=email&utm_campaign=...
Submission: On November 06 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /signup/member_identify
<form accept-charset="UTF-8" action="/signup/member_identify" method="post">
<div style="margin:0;padding:0;display:inline"><input name="utf8" type="hidden" value="✓"><input name="authenticity_token" type="hidden" value="ogzz+gM3pv95pK2c4aqRXIPt2eQwhDJ8StWsELTTLi8="></div>
<script>
$(document).ready(function() {
function isVisibleFormField($formField) {
var cssDisplay = $formField.css('display');
var isVisible;
switch (cssDisplay) {
case 'block':
case 'inline':
case 'inline-block':
case 'flex':
isVisible = true;
break;
default:
isVisible = false;
}
return isVisible;
}
$('.member-birthdate:hidden').removeAttr('name');
$('.member-primary-birthdate:hidden').removeAttr('name');
$("input[type='submit'].register-submit").click(function() {
var validation = true;
if ($('.member-birthdate').length) {
if ($('.member-birthdate').val() == "") {
$('.member-birthdate:visible').focus().addClass('error');
$('.member-birthdate ~ .alertbox').html('Date of Birth is a required field.');
validation = false;
} else {
var today = new Date();
var dateEntered = Date.parse($('.member-birthdate:visible').val());
if (dateEntered > today) {
$('.member-birthdate:visible').focus().addClass('error');
$('.member-birthdate:visible ~ .alertbox').html('Please enter a valid Date of Birth.');
validation = false;
} else {
$('.member-birthdate:visible').removeClass('error');
$('.member-birthdate:visible ~ .alertbox').html('');
}
}
}
if (validation == false) {
return false;
}
});
});
</script>
<!-- Form Start Here -->
<div id="insurance_data_content">
<input id="secondary_registration" name="secondary_registration" type="hidden" value="true">
<input id="affiliation_id" name="affiliation_id" type="hidden" value="1056">
<div class="info">
<h2 class="wrapper">Activate Your Account</h2>
<div id="register-banner">
<div id="errorbox" class="alertbox rounded10" style="display:none;">
<img src="/images/vader/alert.png" align="absmiddle" alt="alert icon"> Missing Required Fields
</div>
<div class="form-wrapper">
<div class="smallheader"> Welcome to MDLIVE. Please activate your account below. </div>
<h2 class="mobile mobile-header">Member Registration</h2>
<table class="table-moniker">
<tbody>
<tr>
<td colspan="2" class="table-moniker-instructions">Please enter your Blue Cross and Blue Shield of Illinois (BCBSIL) Member ID number and Date of Birth.</td>
</tr>
<tr>
<td><br>All fields are required.<br><br></td>
</tr>
<tr>
<td>
<label for="sub">BCBSIL Member ID# <img alt="Question_mark" class="tooltip_element cboxElement" height="16" src="/images/vader/question_mark.png?1524167917" style="margin: 5px 5px 0px;" width="16"><em
class="tooltip_element cboxElement" style="font-size: 16px; cursor: pointer; color: #0096da; position: absolute; border-bottom: 1px dotted #0096da; margin-top: 1px; margin-left:1px;">see an example</em></label><input
id="caf_member_id" name="member[caf_member_id]" type="text" class="formfield rounded10" placeholder="BCBSIL Member ID" size="13" maxlength="200">
<div class="alertbox"></div>
</td>
</tr>
<tr>
<td>
<input type="text" name="member[birthdate]" placeholder="Date of Birth - MM/DD/YYYY" class="formfield member-birthdate birthdate-desktop hasDatepicker" id="dp1636162422364">
<div class="alertbox"></div>
</td>
</tr>
</tbody>
</table>
<p class="member_id_examples">If you are a dependent, please enter your <span style="color:green; font-weight:600">Primary's</span> Member ID and <span style="color:green; font-weight:600">your</span> Date of Birth.</p>
<input type="submit" class="register-submit" value="Continue">
</div>
</div>
</div>
</div>
</form>Text Content
* Home * Activate Now * FAQs * Contact Us * Sign In Email * Sign In * Already Registered? * Activate Now * Home * Activate Now * FAQs * Contact Us ACTIVATE YOUR ACCOUNT Missing Required Fields Welcome to MDLIVE. Please activate your account below. MEMBER REGISTRATION Please enter your Blue Cross and Blue Shield of Illinois (BCBSIL) Member ID number and Date of Birth. All fields are required. BCBSIL Member ID# see an example If you are a dependent, please enter your Primary's Member ID and your Date of Birth. WHAT YOU GET Speak with a doctor anytime, anywhere by secure video or phone Choose a board-certified doctor from the largest telehealth network in the U.S. Your prescriptions sent instantly to your pharmacy of choice (if appropriate) 24/7 Customer Support Private, secure and confidential visits MDLIVE APP Doctor visits are easier and more convenient with the MDLIVE Mobile App. Be prepared. Download today. -------------------------------------------------------------------------------- Copyright © 2021 MDLIVE Inc. All Rights Reserved.Version 2.21 * Privacy Policy * Terms of Use * Disclaimers * Notice of Non-Discrimination Copyright © 2021 MDLIVE, Inc. All rights reserved. Copyright © 2021 MDLIVE Medical Group, PA. All rights reserved. MDLIVE Medical Group, PA provides the clinical services for MDLIVE. MDLIVE Medical Group, PA is an independent entity. Blue Cross and Blue Shield of Illinois is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. MDLIVE is an independent company that does not provide Blue Cross and Blue Shield of Illinois products or services. MDLIVE is solely responsible for the virtual visits products and services it provides.