Get a Quote - Employers | UPMC Health Plan

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Thank you for your patience as we resolve these issues.</div> </div> </div> <nav class="main-nav" aria-label="Main Navigation" > <div class="inner-wrap cf"> <div class="desktop-menu-2019" id="mega-nav" > <div class="cbp-hrmenu"> <ul class="mobile-border-bottom"> <li class="mobile main-nav-hr"></li> <li class="main-menu-item"><a href="#">For Individuals & Families </a> <div class="cbp-hrsub"> <div class="cbp-hrsub-inner"> <div> <section class="upmchp-mega-section section-line-break"> <h2 class="upmchp-subheading"><a href="/individuals/" class="display-link-arrow-mainNav" style="padding:unset !important;">For Individual & Family Coverage</a></h2> <p>Learn the basics of how health insurance works—and how UPMC Health Plan's individual and family plans works for you.</p> <p>UPMC Health Plan Marketplace information:</p> <ul class="links-2019"> <li><a href="/individuals/learn/health-care-benefits/">Benefits of Membership</a></li> <li><a href="/individuals/learn/health-insurance-basics/">Health Insurance Basics</a></li> <li><a href="/individuals/learn/health-care-reform/">Health Care Reform</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="upmchp-subheading">For Our Government Plan Options</h2> <p>Information on our other individual and family plans:</p> <ul class="links-2019"> <li><a href="/medicare/">Medicare Plans</a></li> <li><a href="/medicaid/">Medical Assistance (Medicaid)</a></li> <li><a href="/coverage-for-kids/">Children's Health Insurance Plans (CHIP)</a></li> <li><a href="/chc/">Community HealthChoices (CHC)</a></li> <li><a href="/snp/">Special Needs Plans (SNP)</a></li> </ul> </section> </div> <div style="background-color: #e2e4e6;"> <section class="upmchp-mega-section section-line-break-no-mobile"> <p>Shop for a plan the way you choose. If you're already a member, you can manage your plan right here or log in to your personalized member portal.</p> <ul class="links-2019"> <li><a href="/individuals/learn/plans-and-services/">Shop for Plans Online</a></li> <li><a href="/members/self-service-resources/how-to-pay-your-bill/">Pay Your Bill</a></li> <li><a href="/connect-centers/">Shop for Plans in Person</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-person-icon upmchp-subheading-title-case no-mobile">Member Sign In</h2>  <ul class="links-2019"> <li><a href="/members/access">Sign In</a></li> <li><a href="/register.aspx ">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <ul class="lists-2019"> <li> <p>Individual Sales: <br /> <span class="purple-text-nav"><a href="tel:+1-877-563-0292">1-877-563-0292</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> <li> <p>Group Sales: <br /> <span class="purple-text-nav"><a href="tel:+1-888-383-8762">1-888-383-8762</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> </ul> </section> </div> </div> </div> </li> <li class="mobile main-nav-hr"></li> <li class="main-menu-item"><a href="#">For Employers & Producers</a> <div class="cbp-hrsub"> <div class="cbp-hrsub-inner"> <div> <section class="upmchp-mega-section section-line-break-no-mobile"> <h2 class="upmchp-subheading"><a href="/employers" class="display-link-arrow-mainNav" style="padding:unset !important;">For Employers</a></h2> <p>Healthy employees are happier, more productive, and have fewer absences. Learn how UPMC Health Plan can help your employees live their healthiest lives.</p> <ul class="links-2019"> <li><a href="/employers/plans-and-services/">Products, Plans & Services</a></li> <li><a href="/employers/why-choose-upmc/">The Value of UPMC Health Plan</a></li> <li><a href="/employers/get-a-quote/">Shop for Plans Online</a></li> <li><a href="/employers/student/">Student </a></li> <li><a href="/employers/blog/">Employer Blog</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-suitcase-icon upmchp-subheading-title-case no-mobile">Employer Sign In</h2> <ul class="links-2019"> <li><a href="/employers/access/">Sign In</a></li> <li><a href="/eolregistration/registration.aspx">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <ul class="lists-2019"> <li> <p>Prospective Clients: <br /> <span class="purple-text-nav"><a href="tel:+1-888-383-8762">1-888-383-8762</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> <li> <p>Current Clients: <br /> <span class="purple-text-nav"><a href="tel:+1-888-937-0745">1-800-937-0745</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> </ul> </section> </div> <div style="background-color:#e2e4e6;"> <section class="upmchp-mega-section section-line-break-no-mobile"> <h2 class="upmchp-subheading"><a href="/producers" class="display-link-arrow-mainNav" style="padding:unset !important;">For Producers</a></h2> <p>Start the process of becoming a UPMC Health Plan producer or log in to your existing Producer OnLine account.</p> <ul class="links-2019"> <li><a href="/producers/become-a-upmc-health-plan-producer/">Become a Producer</a></li> <li><a href="http://embed.widencdn.net/pdf/plus/upmc/pwkdpzr3gk/Producer_Digital_ACA-Quick-Reference-Guide_Web.pdf" target="_blank">ACA Quick Reference Guide</a></li> <li><a href="/employers/learn/plans-and-services/">Products, Plans & Services</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-person-icon upmchp-subheading-title-case no-mobile">Producer Sign In</h2> <ul class="links-2019"> <li><a href="/producers/">Sign In</a></li> <li><a href="/producers/become-a-upmc-health-plan-producer/">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <p> Employer Group Services: <span class="purple-text-nav"><a href="tel:+1-888-499-6922">1-888-499-6922</a></span><br /> TTY: <span class="purple-text-nav">711</span> </p> </section> </div> </div> </div> </li> <li class="mobile main-nav-hr"></li> <li class="main-menu-item" ><a href="#">For Members</a> <div class="cbp-hrsub"> <div class="cbp-hrsub-inner"> <div> <section class="upmchp-mega-section"> <h2 class="upmchp-subheading"><a href="/members" class="display-link-arrow-mainNav" style="padding:unset !important;">For Members</a></h2> <p>As a UPMC Health Plan member, you have access to much more than top-ranked care. Your plan includes online health tools, award-winning customer service, health and wellness programs, travel coverage, and many more benefits and services. </p> <ul class="links-2019"> <li><a href="/members/health-plan-basics/">Health Plan Basics</a></li> <li><a href="/members/self-service-resources/">Self-Service Resources</a></li> <li><a href="/members/condition-support/womens-health/">Women's Health</a></li> <li><a href="/members/wellness/">Wellness</a></li> <li><a href="/members/digital-tools/">Digital Tools</a></li> <li><a href="/members/health-plan-basics/spending-accounts/">Spending Accounts</a></li> <li><a href="/connect-centers/">Visit our Locations</a></li> <li><a href="https://www.upmchealthplan.com/members/condition-support/behavioral-health">Behavioral Health</a></li> </ul> </section> </div> <div style="background-color: #e2e4e6;"> <section class="upmchp-mega-section section-line-break-no-mobile"> <p>Manage the nuts and bolts of your plan from right here, or log in to your personalized member portal.</p> <ul class="links-2019"> <li><a href="/marketplace/reenroll/">Renew Your Insurance</a></li> <li><a href="/members/self-service-resources/how-to-pay-your-bill/">Pay Your Bill</a></li> <li><a href="/members/self-service-resources/commonly-used-forms/">Plan Documents</a></li> <li><a href="https://findcare.upmchealthplan.com/find">Find Care</a></li> <li><a href="/members/digital-tools/mobile-app.aspx">Download the App</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-person-icon upmchp-subheading-title-case no-mobile">Member Sign In</h2>  <ul class="links-2019"> <li><a href="/members/access">Sign In</a></li> <li><a href="/register.aspx ">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <p> Current Members: <span class="purple-text-nav"><a href="tel:+1-844-220-4785">1-844-220-4785</a></span><br /> TTY: <span class="purple-text-nav">711</span> </p> </section> </div> </div> </div> </li> <li> <ul style="list-style:none;" aria-label="Mobile navigation menu"> <li class="mobile mobile-nav-extras main-menu-item" role="menuitem"><a href="/providers">For Providers</a></li> <li class="mobile mobile-nav-extras mobile-nav-find-care main-menu-item" role="menuitem" style="border-bottom:none;background-color:#e2e4e6;"><a href="https://findcare.upmchealthplan.com/find">Find Care</a></li> <li class="mobile mobile-nav-extras main-menu-item" role="menuitem"><a href="/contact/default.aspx">CONTACT US</a></li> </ul> </li> </ul> </div> </div> <div class="mobile-nav-2019" style="float:right;background-color:#fff; width:100%;"> <div style="float: left;"> <a href="/"><img src="/img/logo-mobile.png" style="padding:3% 0 0 0;/*border:solid 1px green;*/margin-left:0!important;width:200px;" class="mobile-logo" alt="UPMC Health Plan"/></a> </div> <div style="float:right;"> <div class="top-nav-items"> <a href="/members"><img src="/img/home/2019/mobile-login.png" style="width:20px;height:29px;" alt="Member login." /></a> </div> <div class="top-nav-items search-mobile-icon"> <a href="/search.aspx"> <img src="/img/home/2019/search-top-nav.png" style="width:28px;height:29px;" alt="Search." /></a> </div> <span style="margin-right:15px;margin-top:10px;margin-left:15px;color:#771b61; font-size:30px;cursor:pointer;float:right;" onclick="openNav()" tabindex="0" aria-label="Navigation" role="button" aria-expanded="false" >☰</span> </div> <div id="overlay-function" class="overlay mobile-nav-2019" style="overflow-y:auto;"> <div style="word-wrap:normal;background-color:#fff; height:110px;width:100%;padding-top:2%;padding-bottom:0em !important;margin-bottom:0px !important;"> <div style="float: left;"> <a href="/"> <img src="/img/logo-mobile.png" style="padding:3% 0 0 0;" class="mobile-logo" alt="UPMC Health Plan"/></a> </div> <div style="float:right;"> <div class="top-nav-items"> <a href="/members"> <img src="/img/home/2019/mobile-login.png" style="width:20px;height:29px;" alt="Login or Register." /></a> </div> <div class="top-nav-items search-mobile-icon"> <a href="/search.aspx"> <img src="/img/home/2019/search-top-nav.png" style="width:28px;height:29px;" alt="Search." /></a> </div> <span style="margin-right:20px;margin-top:5px;margin-left:15px;color:#771b61; font-size:34px;cursor:pointer;float:right;" onclick="closeNav()" aria-label="Navigation" role="button" aria-expanded="true" >×</span> </div> <br /> <br /><a href="#" class="main-menu" onclick="mainNav()" style="background-color:#e2e4e6;margin-bottom:0px !important;padding-bottom:0em !important; height:50px;display:none;font-size:18px; margin-top:4%;border-top:solid 1px #e2e4e6;color:#323e48;font-weight:500;text-decoration:none;"> <img src="/img/home/2019/back-black-carat.png" alt="" style="margin-right:2%;vertical-align:middle;" /> Back</a> <div class="cbp-hrmenu"> <ul class="mobile-border-bottom"> <li class="mobile main-nav-hr"></li> <li class="main-menu-item"><a href="#">For Individuals & Families </a> <div class="cbp-hrsub"> <div class="cbp-hrsub-inner"> <div> <section class="upmchp-mega-section section-line-break"> <h2 class="upmchp-subheading"><a href="/individuals/" class="display-link-arrow-mainNav" style="padding:unset !important;">For Individual & Family Coverage</a></h2> <p>Learn the basics of how health insurance works—and how UPMC Health Plan's individual and family plans works for you.</p> <p>UPMC Health Plan Marketplace information:</p> <ul class="links-2019"> <li><a href="/individuals/learn/health-care-benefits/">Benefits of Membership</a></li> <li><a href="/individuals/learn/health-insurance-basics/">Health Insurance Basics</a></li> <li><a href="/individuals/learn/health-care-reform/">Health Care Reform</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="upmchp-subheading">For Our Government Plan Options</h2> <p>Information on our other individual and family plans:</p> <ul class="links-2019"> <li><a href="/medicare/">Medicare Plans</a></li> <li><a href="/medicaid/">Medical Assistance (Medicaid)</a></li> <li><a href="/coverage-for-kids/">Children's Health Insurance Plans (CHIP)</a></li> <li><a href="/chc/">Community HealthChoices (CHC)</a></li> <li><a href="/snp/">Special Needs Plans (SNP)</a></li> </ul> </section> </div> <div style="background-color: #e2e4e6;"> <section class="upmchp-mega-section section-line-break-no-mobile"> <p>Shop for a plan the way you choose. If you're already a member, you can manage your plan right here or log in to your personalized member portal.</p> <ul class="links-2019"> <li><a href="/individuals/learn/plans-and-services/">Shop for Plans Online</a></li> <li><a href="/members/self-service-resources/how-to-pay-your-bill/">Pay Your Bill</a></li> <li><a href="/connect-centers/">Shop for Plans in Person</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-person-icon upmchp-subheading-title-case no-mobile">Member Sign In</h2>  <ul class="links-2019"> <li><a href="/members/access">Sign In</a></li> <li><a href="/register.aspx ">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <ul class="lists-2019"> <li> <p>Individual Sales: <br /> <span class="purple-text-nav"><a href="tel:+1-877-563-0292">1-877-563-0292</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> <li> <p>Group Sales: <br /> <span class="purple-text-nav"><a href="tel:+1-888-383-8762">1-888-383-8762</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> </ul> </section> </div> </div> </div> </li> <li class="mobile main-nav-hr"></li> <li class="main-menu-item"><a href="#">For Employers & Producers</a> <div class="cbp-hrsub"> <div class="cbp-hrsub-inner"> <div> <section class="upmchp-mega-section section-line-break-no-mobile"> <h2 class="upmchp-subheading"><a href="/employers" class="display-link-arrow-mainNav" style="padding:unset !important;">For Employers</a></h2> <p>Healthy employees are happier, more productive, and have fewer absences. Learn how UPMC Health Plan can help your employees live their healthiest lives.</p> <ul class="links-2019"> <li><a href="/employers/plans-and-services/">Products, Plans & Services</a></li> <li><a href="/employers/why-choose-upmc/">The Value of UPMC Health Plan</a></li> <li><a href="/employers/get-a-quote/">Shop for Plans Online</a></li> <li><a href="/employers/student/">Student </a></li> <li><a href="/employers/blog/">Employer Blog</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-suitcase-icon upmchp-subheading-title-case no-mobile">Employer Sign In</h2> <ul class="links-2019"> <li><a href="/employers/access/">Sign In</a></li> <li><a href="/eolregistration/registration.aspx">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <ul class="lists-2019"> <li> <p>Prospective Clients: <br /> <span class="purple-text-nav"><a href="tel:+1-888-383-8762">1-888-383-8762</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> <li> <p>Current Clients: <br /> <span class="purple-text-nav"><a href="tel:+1-888-937-0745">1-800-937-0745</a></span><br class="no-mobile" /> TTY: <span class="purple-text-nav">711</span></p> </li> </ul> </section> </div> <div style="background-color:#e2e4e6;"> <section class="upmchp-mega-section section-line-break-no-mobile"> <h2 class="upmchp-subheading"><a href="/producers" class="display-link-arrow-mainNav" style="padding:unset !important;">For Producers</a></h2> <p>Start the process of becoming a UPMC Health Plan producer or log in to your existing Producer OnLine account.</p> <ul class="links-2019"> <li><a href="/producers/become-a-upmc-health-plan-producer/">Become a Producer</a></li> <li><a href="http://embed.widencdn.net/pdf/plus/upmc/pwkdpzr3gk/Producer_Digital_ACA-Quick-Reference-Guide_Web.pdf" target="_blank">ACA Quick Reference Guide</a></li> <li><a href="/employers/learn/plans-and-services/">Products, Plans & Services</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-person-icon upmchp-subheading-title-case no-mobile">Producer Sign In</h2> <ul class="links-2019"> <li><a href="/producers/">Sign In</a></li> <li><a href="/producers/become-a-upmc-health-plan-producer/">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <p> Employer Group Services: <span class="purple-text-nav"><a href="tel:+1-888-499-6922">1-888-499-6922</a></span><br /> TTY: <span class="purple-text-nav">711</span> </p> </section> </div> </div> </div> </li> <li class="mobile main-nav-hr"></li> <li class="main-menu-item" ><a href="#">For Members</a> <div class="cbp-hrsub"> <div class="cbp-hrsub-inner"> <div> <section class="upmchp-mega-section"> <h2 class="upmchp-subheading"><a href="/members" class="display-link-arrow-mainNav" style="padding:unset !important;">For Members</a></h2> <p>As a UPMC Health Plan member, you have access to much more than top-ranked care. Your plan includes online health tools, award-winning customer service, health and wellness programs, travel coverage, and many more benefits and services. </p> <ul class="links-2019"> <li><a href="/members/health-plan-basics/">Health Plan Basics</a></li> <li><a href="/members/self-service-resources/">Self-Service Resources</a></li> <li><a href="/members/condition-support/womens-health/">Women's Health</a></li> <li><a href="/members/wellness/">Wellness</a></li> <li><a href="/members/digital-tools/">Digital Tools</a></li> <li><a href="/members/health-plan-basics/spending-accounts/">Spending Accounts</a></li> <li><a href="/connect-centers/">Visit our Locations</a></li> <li><a href="https://www.upmchealthplan.com/members/condition-support/behavioral-health">Behavioral Health</a></li> </ul> </section> </div> <div style="background-color: #e2e4e6;"> <section class="upmchp-mega-section section-line-break-no-mobile"> <p>Manage the nuts and bolts of your plan from right here, or log in to your personalized member portal.</p> <ul class="links-2019"> <li><a href="/marketplace/reenroll/">Renew Your Insurance</a></li> <li><a href="/members/self-service-resources/how-to-pay-your-bill/">Pay Your Bill</a></li> <li><a href="/members/self-service-resources/commonly-used-forms/">Plan Documents</a></li> <li><a href="https://findcare.upmchealthplan.com/find">Find Care</a></li> <li><a href="/members/digital-tools/mobile-app.aspx">Download the App</a></li> </ul> </section> <section class="upmchp-mega-section section-line-break"> <h2 class="login-header-person-icon upmchp-subheading-title-case no-mobile">Member Sign In</h2>  <ul class="links-2019"> <li><a href="/members/access">Sign In</a></li> <li><a href="/register.aspx ">Register</a></li> </ul> </section> <section class="upmchp-mega-section"> <h2 class="login-header-phone-icon upmchp-subheading-title-case">Contact Us</h2> <p> Current Members: <span class="purple-text-nav"><a href="tel:+1-844-220-4785">1-844-220-4785</a></span><br /> TTY: <span class="purple-text-nav">711</span> </p> </section> </div> </div> </div> </li> <li> <ul style="list-style:none;" aria-label="Mobile navigation menu"> <li class="mobile mobile-nav-extras main-menu-item" role="menuitem"><a href="/providers">For Providers</a></li> <li class="mobile mobile-nav-extras mobile-nav-find-care main-menu-item" role="menuitem" style="border-bottom:none;background-color:#e2e4e6;"><a href="https://findcare.upmchealthplan.com/find">Find Care</a></li> <li class="mobile mobile-nav-extras main-menu-item" role="menuitem"><a href="/contact/default.aspx">CONTACT US</a></li> </ul> </li> </ul> </div> </div> </div> </div> </div> </nav> <main class="main-content" id="main-skip"> <div class="inner-wrap cf"> <div class="inner-wrap cf" style="border-bottom: 1px solid #d4d4d4 !important;"> <p class="sub-header-section"><a href="/employers/default.aspx">For Employers</a></p> </div> <div class="flex-header-text-image-home" > <div class="form-header"> <h1 class="main-header-page">Health plans for employers of all sizes</h1> <br /> <br /> </div> <div class="homeimg"> </div> </div> <div class="three-checkmark-row"> <div>Flexible plans tailored to business size and employee makeup</div> <div>Award-winning customer service**</div> <div>Easy-to-use online tools from plan administration to enrollment</div> </div> <div class="mega-nav-full-pg-width gray-top-triangle"> <div class="get-quote-div"> <h2 class="quote-heading">Request a Quote</h2> <p class="required-text"> <abbr title="required">*</abbr>indicates required field </p> <div id="quote-form" class="quote-form"> <div id="error_msg" aria-live="polite" aria-atomic="true" class="quote-error"></div> <input name="ctl00$ctl00$cphMainContent$cphHomeContent$Campaign_ID" type="hidden" id="Campaign_ID" value="701d0000000lBkMAAU" /> <input name="ctl00$ctl00$cphMainContent$cphHomeContent$digital_tactic" type="hidden" id="digital_tactic" /> <div class="form-table"> <div class="form-tr"> <div class="form-tc"> <label for="first_name">First Name<abbr title="required">*</abbr></label><input name="ctl00$ctl00$cphMainContent$cphHomeContent$first_name" type="text" id="first_name" maxlength="40" required="" /> </div> <div class="form-tc"> <label for="last_name">Last Name<abbr title="required">*</abbr></label><input name="ctl00$ctl00$cphMainContent$cphHomeContent$last_name" type="text" id="last_name" maxlength="80" required="" /> </div> </div> <div class="form-tr"> <div class="form-tc"> <label for="company">Company<abbr title="required">*</abbr></label><input name="ctl00$ctl00$cphMainContent$cphHomeContent$company" type="text" id="company" maxlength="40" required="" /> </div> <div class="form-tc"> <label for="zip">Company Zip<abbr title="required">*</abbr></label><input name="ctl00$ctl00$cphMainContent$cphHomeContent$zip" type="text" id="zip" maxlength="5" onkeypress="return onlyNumbers(event);" required="" /> </div> </div> <div class="form-tr"> <div class="form-tc"> <label for="title">Title<abbr title="required">*</abbr></label><input name="ctl00$ctl00$cphMainContent$cphHomeContent$title" type="text" id="title" maxlength="40" required="" /> </div> <div class="form-tc"> <label for="phone">Daytime Phone Number<abbr title="required">*</abbr></label><input name="ctl00$ctl00$cphMainContent$cphHomeContent$phone" type="text" id="phone" maxlength="15" required="" /> </div> </div> <div class="form-tr"> <div class="form-tc"> <label for="employees">Number of Employees<abbr title="required">*</abbr></label> <select name="ctl00$ctl00$cphMainContent$cphHomeContent$employees" id="employees" title="Number of Employees" class="quote-select" required=""> <option value="">--None--</option> <option value="2-50">2-50</option> <option value="51-99">51-99</option> <option value="100 or more">100 or more</option> </select> </div> <div class="form-tc"> <label for="email">Email Address<abbr title="required">*</abbr></label><input name="ctl00$ctl00$cphMainContent$cphHomeContent$email" type="text" id="email" required="" /> </div> </div> <br /> <div id="cphMainContent_cphHomeContent_ctl00_pnlBorder" style="width:304px;"> <div id="dvCaptcha"></div> </div> <span id="cphMainContent_cphHomeContent_ctl00_cvCaptcha" aria-label="verify captcha" style="color:Red;display:none;">Please verify that you are not a robot.</span> <br /><br /> <input type="hidden" name="ctl00$ctl00$cphMainContent$cphHomeContent$ctl00$hdfChange" id="cphMainContent_cphHomeContent_ctl00_hdfChange" value="false" /> <script type="text/javascript" src="https://www.google.com/recaptcha/api.js?onload=onloadCallback&render=explicit" async defer></script> <script type="text/javascript"> var onloadCallback = function () { grecaptcha.render('dvCaptcha', { 'sitekey': '6Le6KGYUAAAAAHYE15VVLcTWXG4vwo-buDb5xOJ7' }); }; function validateCaptcha(src, args) { var response = grecaptcha.getResponse(); args.IsValid = response.length !== 0; } function isCaptchaValid(setBorder) { var response = document.getElementById("g-recaptcha-response").value; var validated = false; $.ajax({ type: 'POST', url: '/services/recaptcha.asmx/VerifyCaptcha', data: "{'response': '" + response + "'}", contentType: 'application/json', dataType: 'json', success: function (data) { var test = JSON.parse(data.d); validated = test.success; }, async: false }); if (setBorder && !validated) { $("#dvCaptcha iframe").addClass("border-red"); } else { $("#dvCaptcha iframe").removeClass("border-red"); } return validated; } </script> <div class="quote-submit"> <input type="submit" name="ctl00$ctl00$cphMainContent$cphHomeContent$btn_GetQuoteSubmit" value="Submit Quote Request" onclick="return validateGetQuoteForm();WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl00$cphMainContent$cphHomeContent$btn_GetQuoteSubmit", "", true, "", "", false, false))" id="cphMainContent_cphHomeContent_btn_GetQuoteSubmit" class="orchid500-button" role="button" /> <p>- or 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