www.coveredca.com Open in urlscan Pro
23.99.0.12  Public Scan

Submitted URL: https://click.marketing.coveredca.com/?qs=a795071722069e7c1991e132f582e2c90194766b3ddd3f956031af8a3de6e169c51b03da9bcfc5b166f5f4195fe1...
Effective URL: https://www.coveredca.com/support/before-you-buy/what-is-open-enrollment/?utm_source=SFMC&utm_medium=email&utm_campaign=C2...
Submission: On June 19 via api from US — Scanned from DE

Form analysis 5 forms found in the DOM

/site-search.html

<form class="form-inline my-2 my-lg-0 py-3 px-3 d-lg-none nav-site-search-form" action="/site-search.html">
  <div class="position-relative w-100">
    <div class="row">
      <div class="col-12">
        <div class="input-group d-flex align-items-start w-100">
          <input type="hidden" class="d-none" name="index" value="1">
          <input class="form-control nav-site-search-form__input nav-site-search-form__input--mobile" placeholder="Search" aria-label="Search" name="query" type="text">
          <button class="btn border-left-0 border-radius-0 border-raidus-top-right-1 border-raidus-bottom-right-1 px-2 p-0 d-flex align-items-center border-gray-light" style="height: 40px;right: -1px" type="submit">
            <i class="material-icons text-primary">search</i>
          </button>
        </div>
      </div>
      <div class="col-12 nav-site-search-form__invalid-feedback nav-site-search-form__invalid-feedback--red d-none" id="nav-site-search-input-invalid-feedback">
      </div>
    </div>
  </div>
</form>

/site-search.html

<form action="/site-search.html" class="flex-grow-1 nav-site-search-form" id="site-search-form-nav">
  <div class="form-group mb-0">
    <div class="row">
      <div class="col-10 col-md-11">
        <div class="input-group">
          <div class="input-group-prepend">
            <button type="submit" class="form-control btn btn-white btn-primary-on-hover h-100 d-flex align-items-center border border-right-0" style="left: -1px">
              <i class="material-icons color-primary">search</i>
            </button>
          </div>
          <label for="site-search-input-nav" class="sr-only" style="top:1000px;">Search</label>
          <input type="text" class="form-control nav-site-search-form__input nav-site-search-form__input--desktop" style="border-top-right-radius: 50rem; border-bottom-right-radius: 50rem;" id="site-search-input-nav" name="query"
            placeholder="Search CoveredCA.com">
          <input type="hidden" class="d-none" id="site-search-index-nav" name="index" value="1">
        </div>
      </div>
      <div class="col-2 col-md-1">
        <div class="d-flex h-100 align-items-center">
          <button class="bg-transparent border-0 p-0 search-active-toggle" type="button" style="height: 24px;"><i class="w-24px color-white material-icons">close</i></button>
        </div>
      </div>
      <div class="col-12 nav-site-search-form__invalid-feedback nav-site-search-form__invalid-feedback--white d-none" id="nav-site-search-input-invalid-feedback">
      </div>
    </div>
  </div>
</form>

<form class="sign-up__form subscription w-100" id="footer-subscribe">
  <input type="hidden" name="StateSubsidy" value="true">
  <input type="hidden" name="Source" value="footer">
  <div class="row mx-0">
    <div class="col-12">
      <div class="form-group w-90 mx-auto">
        <label class="text-dark m-0 pl-3" for="Name">First Name</label>
        <input type="text" id="Name" name="Name" class="form-control form-control-sm border border-dark rounded-pill" placeholder="e.g. John">
      </div>
    </div>
    <div class="col-6 ml-2">
      <div class="form-group w-90 mx-auto">
        <label class="text-dark m-0 pl-3" for="Zip">ZIP Code</label>
        <input type="text" id="Zip" name="ZipCode" class="form-control form-control-sm border border-dark rounded-pill" placeholder="12345">
      </div>
    </div>
    <div class="col-12">
      <div class="form-group w-90 mx-auto mb-0">
        <label class="text-dark m-0 pl-3" for="EmailAddress">Email*</label>
        <input type="email" id="EmailAddress" name="EmailAddress" class="form-control form-control-sm border border-dark rounded-pill" placeholder="youremail@example.com" required="">
      </div>
    </div>
    <div class="col-12">
      <div class="w-90 mx-auto">
        <span class="font-size-12px pl-3">* required</span>
      </div>
    </div>
    <div class="col">
      <button type="submit" id="gtm-sign-up" class="sign-up__submit-button--footer btn btn-sm btn-primary d-block mx-auto mt-2 mt-lg-0 px-5">Subscribe</button>
    </div>
  </div>
</form>

<form class="sign-up__form subscription" id="pop-up-subscribe">
  <input type="hidden" name="StateSubsidy" value="true">
  <input type="hidden" name="Source" value="Pop-up">
  <div class="form-group">
    <label class="text-primary" for="fNamePopUp">Enter First Name</label>
    <input id="fNamePopUp" name="fNamePopUp" class="form-control border-primary">
  </div>
  <div class="form-group">
    <label class="text-primary" for="ZipCode">Enter ZIP Code</label>
    <input name="ZipCode" id="ZipCode" class="form-control border-primary">
  </div>
  <div class="form-group">
    <label class="text-primary" for="eAddressPopUp">Enter Email Address (Required)</label>
    <input type="email" id="eAddressPopUp" name="eAddressPopUp" class="form-control border-primary" required="">
  </div>
  <a class="text-center d-inline-block mb-4" href="/privacy">Privacy Policy</a>
  <div class="loading text-center mb-3"><img src="//www.coveredca.com/images/loading.gif" alt="Loading..."></div>
  <div class="col-8 offset-2">
    <button id="signUp" type="submit" class="sign-up__submit-button btn btn-action w-100 gtm-lead-popup-subscribe" disabled="">Subscribe</button>
  </div>
</form>

<form id="calculator-form" class="subsidy-calculator__form py-3 px-3 px-md-0" autocomplete="off">
  <!-- Calculator API Error Message -->
  <div id="subsidy-calculator__calculate-error-message" class="row mr-0 d-none">
    <div class="col">
      <div class="alert alert-danger text-center"> We are experiencing technical difficulties. Please try again later. </div>
    </div>
  </div>
  <!-- Household Income, Zip and County -->
  <div class="row mr-0 align-items-end">
    <!-- Household Income -->
    <div class="col-md-4 py-3">
      <div id="household-income-component-01">
        <div class="household-income-component">
          <!-- HouseholdIncome Label -->
          <div class="mb-2">
            <label class="household-income-component__label font-weight-bold d-inline m-0" for="subsidy-calculator__household-income"> Household Income </label>
            <span id="calculator-tooltip--household-income" data-toggle="tooltip" title="" class="font-18px text-primary cursor-pointer d-inline material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
              data-template="<div class=&quot;tooltip subsidy-calculator__tooltip&quot; role=&quot;tooltip&quot;><div class=&quot;arrow&quot;></div><div class=&quot;tooltip-inner&quot;></div></div>"
              data-original-title="Household income refers to the estimated combined income of all family members for the year you plan to have coverage."> info </span>
          </div>
          <!-- HouseholdIncome Input -->
          <div class="d-flex">
            <input id="subsidy-calculator__household-income" class="household-income-component__input subsidy-calculator__input subsidy-calculator__input-income order-2" placeholder="28,000" type="text">
            <div class="input-group-prepend order-1">
              <span class="subsidy-calculator__dollar-sign">$</span>
            </div>
          </div>
          <!-- HouseholdIncome Invalid Feedback -->
          <div id="subsidy-calculator__household-income-invalid-feedback" class="household-income-component__invalid-feedback invalid-feedback"> Please enter a number </div>
        </div>
      </div>
    </div>
    <!-- ZIP -->
    <div class="col-6 col-md-4 py-3">
      <div id="zip-component-01">
        <!-- ZIP Code Component -->
        <div class="zip-code-component">
          <!-- Label -->
          <label class="font-weight-bold zip-code-component__label" for="subsidy-calculator__zip-code">ZIP Code</label> <br>
          <!-- Input Group -->
          <div class="d-flex">
            <!-- Input -->
            <input id="subsidy-calculator__zip-code" class="zip-code-component__input subsidy-calculator__input" placeholder="95834" type="text">
            <!-- Location Button -->
            <div class="input-group-append">
              <span class="input-group-text icon-styles subsidy-calculator__form-control">
                <button class="subsidy-calculator__flat-button gtm-calculator-geolocation zip-code-component__location-button" type="button">
                  <span class="sr-only">location</span>
                  <svg class="subsidy-calculator__icon-primary" focusable="false" viewBox="0 0 24 24" aria-hidden="true">
                    <path
                      d="M12 8c-2.21 0-4 1.79-4 4s1.79 4 4 4 4-1.79 4-4-1.79-4-4-4zm8.94 3c-.46-4.17-3.77-7.48-7.94-7.94V1h-2v2.06C6.83 3.52 3.52 6.83 3.06 11H1v2h2.06c.46 4.17 3.77 7.48 7.94 7.94V23h2v-2.06c4.17-.46 7.48-3.77 7.94-7.94H23v-2h-2.06zM12 19c-3.87 0-7-3.13-7-7s3.13-7 7-7 7 3.13 7 7-3.13 7-7 7z">
                    </path>
                  </svg>
                </button>
              </span>
            </div>
          </div>
          <!-- Invalid Feedback -->
          <div class="zip-code-component__invalid-feedback invalid-feedback"> Please enter a valid ZIP code </div>
        </div>
      </div>
    </div>
    <!-- County -->
    <div class="col-6 col-md-4 py-3">
      <div id="county-01" class="d-none">
        <div class="county-component">
          <label class="county-component__label font-weight-bold" for="subsidy-calculator__county">County</label> <br>
          <select id="subsidy-calculator__county" class="county-component__input subsidy-calculator__select">
            <option value="Sacramento">Sacramento</option>
          </select>
        </div>
      </div>
    </div>
  </div>
  <!-- Household Size, How many need coverage, coverage year-->
  <div class="row mr-0 align-items-end">
    <div id="household-size" class="col-6 col-md-4 py-3">
      <div class="household-size-component subsidy-calculator__household-size">
        <div class="mb-2">
          <label class="household-size-component__label font-weight-bold d-inline m-0" for="subsidy-calculator__household-size"> Household Size </label>
          <span id="calculator-tooltip--household-size" data-toggle="tooltip" data-placement="right" title="" class="font-18px text-primary cursor-pointer material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
            data-template="<div class=&quot;tooltip subsidy-calculator__tooltip&quot; role=&quot;tooltip&quot;><div class=&quot;arrow&quot;></div><div class=&quot;tooltip-inner&quot;></div></div>"
            data-original-title="Include only the tax filer and any spouse or dependents (even if they aren’t applying for insurance)."> info </span>
        </div>
        <select id="subsidy-calculator__household-size" class="subsidy-calculator__select household-size-component__input">
          <option value="1">1</option>
          <option value="2">2</option>
          <option value="3">3</option>
          <option value="4">4</option>
          <option value="5">5</option>
          <option value="6">6</option>
          <option value="7">7</option>
          <option value="8">8</option>
        </select>
        <div role="alert">
          <div id="subsidy-calculator__household-size-invalid-feedback" class="invalid-feedback household-size-component__invalid-feedback"> Household size must be the same or more than how many need coverage. </div>
        </div>
      </div>
    </div>
    <div id="need-coverage" class="col-6 col-md-4 py-3">
      <div class="need-coverage-component">
        <label class="need-coverage-component__label font-weight-bold" for="subsidy-calculator__need-coverage">How many need coverage?</label> <br>
        <select id="subsidy-calculator__need-coverage" class="need-coverage-component__input subsidy-calculator__select">
          <option value="1">1</option>
          <option value="2">2</option>
          <option value="3">3</option>
          <option value="4">4</option>
          <option value="5">5</option>
          <option value="6">6</option>
          <option value="7">7</option>
          <option value="8">8</option>
        </select>
        <div role="alert">
          <div id="subsidy-calculator__need-coverage-invalid-feedback" class="need-coverage-component__invalid-feedback invalid-feedback"> Cannot be more than the household size </div>
        </div>
      </div>
    </div>
    <div id="coverage-year" class="col-12 col-md-4 py-3" style="display: none;">
      <div class="coverage-year-component">
        <div class="mb-2">
          <label class="coverage-year-component__label font-weight-bold d-inline m-0" for="subsidy-calculator__coverage-year"> When do you want to start coverage? </label>
        </div>
        <select disabled="" id="subsidy-calculator__coverage-year" class="coverage-year-component__input subsidy-calculator__select">
          <option value="2022">Next year (2022)</option>
          <option value="2021">This year (2021)</option>
        </select>
        <div class="coverage-year-component__invalid-feedback invalid-feedback" role="alert"> Please enter a coverage year </div>
      </div>
      <script>
        const now = new Date();
        if (now.getFullYear() > 2021) document.getElementById('coverage-year').style.display = 'none';
      </script>
    </div>
  </div>
  <!-- Age of members needing coverage -->
  <div class="row">
    <div id="ages" class="col-12">
      <div class="ages-component pt-4">
        <div class="mb-2">
          <span class="ages-component__label d-inline-block font-weight-bold pr-2"> Age of People Needing Coverage <span id="calculator-tooltip--member-ages" data-toggle="tooltip" data-placement="right" title=""
              class="font-18px text-primary cursor-pointer material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
              data-template="<div class=&quot;tooltip subsidy-calculator__tooltip&quot; role=&quot;tooltip&quot;><div class=&quot;arrow&quot;></div><div class=&quot;tooltip-inner&quot;></div></div>"
              data-original-title="If under one year old, enter &quot;1&quot;. Enter the age you and your household members will be on Jan. 1, 2022."> info </span>
          </span>
          <span id="member-age-label" class="d-none">Age of People Needing Coverage</span>
        </div>
        <!-- Household Member Ages Input Container -->
        <div id="household-members" class="ages-component__ages-container d-flex flex-wrap m-0 w-100">
          <div class="household-member-age mr-2"><label for="dynamic-age-input-1" class="font-weight-bold sr-only"><br> Age of People Needing Coverage<br> <br> info<br> <br> </label><input type="number" id="dynamic-age-input-1"
              class="subsidy-calculator__household-member-age subsidy-calculator__input ages-component__age-input mr-2" placeholder="45"></div>
        </div>
        <div role="alert">
          <div id="household-members-invalid-feedback" class="ages-component__invalid-feedback invalid-feedback"> Please enter a valid age for each person. </div>
        </div>
      </div>
    </div>
  </div>
  <!-- UIB -->
  <div class="row mr-0 align-items-end pt-4">
    <div id="received-unemployment-benefits" class="col-md-8">
      <div class="uib-component d-none">
        <div class="font-weight-bold mb-2"> Received unemployment benefits in 2021? <span id="calculator-tooltip--uib" data-toggle="tooltip" data-placement="right" title=""
            class="font-18px text-primary cursor-pointer ml-2 material-icons-outlined subsidy-calculator__tooltip-trigger" tabindex="0"
            data-template="<div class=&quot;tooltip subsidy-calculator__tooltip&quot; role=&quot;tooltip&quot;><div class=&quot;arrow&quot;></div><div class=&quot;tooltip-inner&quot;></div></div>"
            data-original-title="If yes, your household likely qualifies for Silver 94 plans with lower deductibles, copays, and coinsurance — all for as low as $1 per person."> info </span>
        </div>
        <div class="d-inline-block pr-5 radio-container">
          <label for="yes-unemployment">Yes <input class="uib-component__yes-radio" type="radio" id="yes-unemployment" name="unemployment-benefits" value="yes">
            <span class="custom-radio"></span>
          </label><br>
        </div>
        <div class="d-inline-block radio-container">
          <label for="no-unemployment">No <input class="uib-component__no-radio" type="radio" id="no-unemployment" name="unemployment-benefits" value="no" checked="">
            <span class="custom-radio"></span>
          </label><br>
        </div>
        <div id="received-unemployment-benefits--info" class="subsidy-calculator__uib-info d-none">
        </div>
      </div>
    </div>
  </div>
  <!-- Calculate Button -->
  <div class="row mr-0 mt-auto pt-4">
    <div class="col-12 d-md-flex justify-content-md-end pr-md-5 py-3">
      <div id="calculate">
        <a href="#results-container" id="calculate-desktop" class="subsidy-calculator__calculate-button btn btn-primary px-0 px-lg-5 d-none d-sm-block gtm-calculator-calculate disabled">Calculate</a>
        <a href="#results-container" id="calculate-mobile" class="subsidy-calculator__calculate-btn-mobile btn btn-primary px-5 d-block d-sm-none w-75 mx-auto gtm-calculator-calculate disabled">Calculate</a>
      </div>
    </div>
  </div>
</form>

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WHAT IS OPEN ENROLLMENT?

Open enrollment is the time of year when everyone can apply for a plan through
Covered California. This usually happens from November to January. Outside open
enrollment, people who experience qualifying life events can apply during
special enrollment.

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3.5.2

CALCULATOR

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ESTIMATE WHAT YOU’LL PAY

Estimate what you might pay for your plan with the help of our nifty calculator.

We are experiencing technical difficulties. Please try again later.
Household Income info
$
Please enter a number
ZIP Code

location
Please enter a valid ZIP code
County
Sacramento
Household Size info
1 2 3 4 5 6 7 8
Household size must be the same or more than how many need coverage.
How many need coverage?
1 2 3 4 5 6 7 8
Cannot be more than the household size
When do you want to start coverage?
Next year (2022) This year (2021)
Please enter a coverage year
Age of People Needing Coverage info Age of People Needing Coverage

Age of People Needing Coverage

info


Please enter a valid age for each person.
Received unemployment benefits in 2021? info
Yes

No


Calculate Calculate
Your Estimate $63 per month for a Silver plan. Bronze as low as $0. You may
qualify for: Covered California.
 * You save $507 per month.
 * Brand-name plans.

This isn’t an application for health coverage.


QUICK QUOTE


YOU MAY QUALIFY FOR

done
$63 per month
Medi-Cal
for a Silver plan.
Bronze plans as low as $0.
After financial help from: You may qualify for: You may qualify for: Covered
California both Covered California and no-cost or low-cost coverage through
Medi-Cal. no-cost or low-cost coverage
check_circle Financial Help: $507 per month
check_circle Bronze, Gold and Platinum plans also available
check_circle Coverage for children, adults and families
check_circle Free or affordable pregnancy coverage
check_circle Because of your income, you may be able to sign up now, even if you
don't have another qualifying life event.
Continue
This isn’t an application for health coverage. info
Total Subsidy: $506.80
Members going to cca: 1
Members going to medical: 0
Fed Fairshare: $62.90
FPL%: 217.39130434782606
Percentage of income: 0.0
SLS Benchmark cost: 569.70
SLS Rate: 394.53
Household Rating Factor: 1.44

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