{"submission":{"method":"get","action":"/cwbe/mail","redirect":false,"beforeSubmit":[{"statement":"model.loading = true;"}],"done":[{"statement":"model.loading = false; model.currentPage = 'confirmation';"}],"error":[{"statement":"model.loading = false; model.submissionError = true; window.scrollTo(0,0);"}]},"model":{"type":"object","properties":{"loading":{"type":"boolean","value":false,"omit":true},"currentPage":{"type":"string","value":"form","omit":true},"submissionError":{"type":"boolean","value":false,"omit":true},"dn":{"type":"string"},"au":{"type":"string","value":"/cwbl/ping"},"lu":{"type":"string"},"technicalSupport":{"type":"string","value":"Submit"},"BG":{"type":"string","value":"ih"},"PROFILE":{"type":"string","value":"24cX1e3X1d5X1f8X299X245X253X230X230X229X23eX24c"},"MAIL_FORMAT":{"type":"string","value":"text"},"name_I":{"type":"string","validation":{"required":true}},"email_I":{"type":"string","validation":{"required":true,"regex":{"value":"[^@]+@[^\\.]+\\..+","message":"Email format is invalid."}}},"confirmemail_I":{"type":"string","validation":{"required":true,"condition":{"value":"model.email_I == model.confirmemail_I","message":"Email and Confirm Email must match."}}},"phone_I":{"type":"string","validation":{"required":true}},"contact_time_I":{"type":"string","validation":{"required":true}},"sitearea_I":{"type":"string","enum":["Doctor & Hospital Finder","My Health Toolkit","My Insurance Manager/Providers","Other"],"validation":{"required":true}},"browser_I":{"type":"string","enum":["Firefox","Chrome","Internet Explorer","Safari","Opera","Other","Don't Know"],"validation":{"required":true}},"operatingsystem_I":{"type":"string","enum":["Mac OS","Windows XP","Windows Vista","Windows 7","Windows 8","Windows 10","Linux","iOS","Android","Blackberry","Other","Don't Know"],"validation":{"required":true}},"popupblocker_I":{"type":"string","enum":["Yes","No","Don't Know"],"validation":{"required":true}},"comments_I":{"type":"string","validation":{"required":true}},"browserversion_I":{"type":"string","validation":{"required":true}}}},"form":[{"type":"page","name":"form","model":"currentPage","items":[{"type":"conditional","condition":"model.submissionError","items":[{"type":"alert","variant":"danger","items":["There was a problem when submitting the form. Please try again later."]}]},{"type":"alert","items":[{"type":"strong","items":["IMPORTANT: This is for technical help only! "]},"This form does not go to someone who can answer your claims or benefits questions."]},{"type":"paragraph","items":["If you have a technical question about using our site, please fill out this form and we will respond within one business day. For immediate assistance, please call us at 877-274-1715. Thank you!"]},{"type":"input","title":"Name","model":"name_I","width":"24"},{"type":"input","title":"Email","model":"email_I","width":"24"},{"type":"input","title":"Confirm email","model":"confirmemail_I","width":"24"},{"type":"input","title":"Phone","model":"phone_I","width":"24"},{"type":"input","title":"Best time to contact","model":"contact_time_I","width":"24"},{"type":"select","title":"Area of the website you are having trouble with","model":"sitearea_I","width":"24"},{"type":"flex","items":[{"type":"select","title":"Type of browser you are using","model":"browser_I","width":"16"},{"type":"input","title":"Browser version","model":"browserversion_I","width":"6"}]},{"type":"paragraph","items":["To find out what type of browser you have, click on Help at the top of your browser window. Click on \"About (Browser Name)\" and you should see a screen indicating what type and version of browser is running. For example, \"Firefox version 50.0\" or \"Internet Explorer version 11.0.\""]},{"type":"select","title":"Operating system you are using","model":"operatingsystem_I","width":"24"},{"type":"radio-group","title":"Do you have your pop-up blocker turned off?","model":"popupblocker_I"},{"type":"textarea","title":"Question/Concern","model":"comments_I"},{"type":"button","title":"Submit Technical Issue","variant":"primary","loading":"loading","submit":true}]},{"type":"page","name":"confirmation","model":"currentPage","items":[{"type":"alert","variant":"success","items":["Thank you for your submission! We will get back to you within one business day."]}]}],"config":{"dndEditing":true}}