{"id":44929,"date":"2026-05-08T10:31:47","date_gmt":"2026-05-08T14:31:47","guid":{"rendered":"https:\/\/elderplan0.wpengine.com\/?page_id=44929"},"modified":"2026-05-08T10:31:51","modified_gmt":"2026-05-08T14:31:51","slug":"test-of-customer-service-form","status":"publish","type":"page","link":"https:\/\/elderplan0.wpengine.com\/zh\/test-of-customer-service-form\/","title":{"rendered":"Test of Customer Service Form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f44928-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"44928\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/zh\/wp-json\/wp\/v2\/pages\/44929#wpcf7-f44928-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-auto-return-first-step cf7mls-no-moving-animation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"44928\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f44928-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:44928,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-step-2&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;elderplan-member-id&quot;,&quot;operator&quot;:&quot;not empty&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;group-step-3&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;birthday&quot;,&quot;operator&quot;:&quot;not empty&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;group-step-4&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;help-dropdown&quot;,&quot;operator&quot;:&quot;not empty&quot;,&quot;if_value&quot;:&quot;&quot;}]},{&quot;then_field&quot;:&quot;group-submit&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;message&quot;,&quot;operator&quot;:&quot;not empty&quot;,&quot;if_value&quot;:&quot;&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;notice_dismissed_update-cf7-5.9.8&quot;:true,&quot;notice_dismissed_update-cf7-6.0&quot;:true,&quot;notice_dismissed_update-cf7-6.0.1&quot;:true,&quot;notice_dismissed_update-cf7-6.0.2&quot;:true,&quot;notice_dismissed_update-cf7-6.0.3&quot;:true,&quot;notice_dismissed_update-cf7-6.0.6&quot;:true,&quot;notice_dismissed_update-cf7-6.1.1&quot;:true,&quot;notice_dismissed_update-cf7-6.1.3&quot;:true}}\" \/><input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.5\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<div class=\"cf7-landing-page-form customer-service\">\n\t<div class=\"screen-reader-response\">\n\t\t<div role=\"status\" aria-live=\"polite\">\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"headline  headline-transform\">\n\t\t<p><strong>Get started,<\/strong> to contact with US.\n\t\t<\/p>\n\t<\/div>\n\n\n <!-- STEP 1  -->\n\t<div class=\"form-step-1 step-member-id landing-page-form__step open\">\n\t\t<div class=\"step-header\">\n\t\t\t<p><span>1<\/span>\n\t\t\t<\/p>\n\t\t\t<p><strong>Please<\/strong> enter your Member ID:\n\t\t\t<\/p>\n\t\t<\/div>\n <!-- Member ID -->\n\t\t<div class=\"member-id-type form-field\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"elderplan-member-id\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Elderplan Member ID\" value=\"\" type=\"text\" name=\"elderplan-member-id\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n <!-- STEP 2  -->\n\t<div data-id=\"group-step-2\" data-orig_data_id=\"group-step-2\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"form-step-2 step-birthday landing-page-form__step\">\n\t\t\t<div class=\"step-header\">\n\t\t\t\t<p><span>2<\/span><br \/>\n<label for=\"birthdate\"><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p><strong>Please<\/strong> enter your Birthdate:\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n <!-- Birthdate field -->\n\t\t\t<div class=\"birthdate-type form-field\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"birthday\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date inline-calendar no-flatpickr\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"birthday\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div data-id=\"group-step-3\" data-orig_data_id=\"group-step-3\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"form-step-3 step-help-dropdown landing-page-form__step\">\n\t\t\t<div class=\"step-header\">\n\t\t\t\t<p><span>3<\/span><br \/>\n<label for=\"help-dropdown\"><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p><strong>What<\/strong> can we help you with?\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n <!-- Help Dropdown -->\n\t\t\t<div class=\"help-dropdown-type form-field\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"help-dropdown\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required help-dropdown\" id=\"help-dropdown\" list=\"help-options\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Start typing...\" value=\"\" type=\"text\" name=\"help-dropdown\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><datalist id=\"help-options\"><br \/>\n<option value=\"Getting the care or services I need.\"><\/option><br \/>\n<option value=\"A service or medication that was denied.\"><\/option><br \/>\n<option value=\"Getting approval for a service or medication.\"><\/option><br \/>\n<option value=\"A bill or claim.\"><\/option><br \/>\n<option value=\"I fear for my safety, and need to speak to someone.\"><\/option><br \/>\n<option value=\"Getting plan documents, materials, or a benefit card.\"><\/option><br \/>\n<option value=\"My eligibility or what my plan covers.\"><\/option><br \/>\n<option value=\"How to file a Grievance.\"><\/option><br \/>\n<option value=\"A general question about my plan.\"><\/option><br \/>\n<option value=\"Updating my personal information.\"><\/option><br \/>\n<option value=\"Using the mobile app.\"><\/option><br \/>\n<option value=\"Concerns with the care I received.\"><\/option><br \/>\n<option value=\"I would like to speak to my care manager or health coach.\"><\/option><br \/>\n<\/datalist>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div data-id=\"group-step-4\" data-orig_data_id=\"group-step-4\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"form-step-4 step-message landing-page-form__step\">\n\t\t\t<div class=\"step-header\">\n\t\t\t\t<p><span>4<\/span><br \/>\n<label for=\"message\"><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p><strong>Please<\/strong> share any other information about your request\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n <!-- Message Dropdown -->\n\t\t\t<div class=\"message-type form-field\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea message-field\" aria-invalid=\"false\" name=\"message\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div data-id=\"group-submit\" data-orig_data_id=\"group-submit\"  class=\"landing-page-form__step\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"term-checkbox\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"disclaimer\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"disclaimer\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">By checking this box I give Elderplan permission to contact me.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\n <!-- Submit Button -->\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send Request\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"Get started, to contact with US. 1 Please enter your Member ID: 2 Please enter your Birthdate: 3 What can we help you with? 4 Please share any other information 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