{"id":484,"date":"2024-07-20T04:49:46","date_gmt":"2024-07-20T04:49:46","guid":{"rendered":"https:\/\/b6benefits.com\/ziggis\/?page_id=484"},"modified":"2026-05-26T09:25:49","modified_gmt":"2026-05-26T14:25:49","slug":"enrollment","status":"publish","type":"page","link":"https:\/\/b6benefits.com\/ziggis\/enrollment\/","title":{"rendered":"Enrollment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"484\" class=\"elementor elementor-484\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0dd0aa4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0dd0aa4\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;background_background&quot;:&quot;classic&quot;,&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-62831e6\" data-id=\"62831e6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e0b24a7 elementor-widget__width-initial dce_masking-none elementor-widget elementor-widget-image\" data-id=\"e0b24a7\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"600\" height=\"540\" src=\"https:\/\/b6benefits.com\/ziggis\/wp-content\/uploads\/2024\/10\/Copy-of-Untitled-Design.png\" class=\"attachment-medium size-medium wp-image-1175\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-58edcae\" data-id=\"58edcae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-942b842 elementor-widget elementor-widget-gva-heading-block\" data-id=\"942b842\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"gva-heading-block.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"gva-element-gva-heading-block gva-element\">   <div class=\"align-left style-1 widget gsc-heading box-align-left auto-responsive\">\r\n      <div class=\"content-inner\">\r\n         \r\n                  \r\n         <div class=\"sub-title\"><span class=\"tagline\">2026<\/span><\/div>  \r\n         \r\n                     <h2 class=\"title\">\r\n               <span>Enroll in your Benefit Offers<\/span>\r\n            <\/h2>\r\n                  \r\n                     <div class=\"title-desc\">Easily enroll in your new benefits offered to you by Ziggi's Coffee. Follow the instructions on the form below to continue.\n\n<\/div>\r\n         \r\n         \r\n      <\/div>\r\n   <\/div>\r\n<\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-779faed elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"779faed\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0228879\" data-id=\"0228879\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-acdec62 eael-gravity-form-button-custom elementor-widget elementor-widget-eael-gravity-form\" data-id=\"acdec62\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"eael-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t<div class=\"eael-contact-form eael-gravity-form eael-contact-form-align-default\">\n\t\t        \n            <script type=\"text\/javascript\">\n                \/* EA Gravity Forms - fallback dispatch of GF's per-form post-render event.\n                 *\n                 * GF normally dispatches this itself from GFFormDisplay::footer_init_scripts().\n                 * In render contexts where that never runs, GF add-ons that bind to\n                 * `gform\/post_render` - e.g. the reCAPTCHA Add-On v2.2.2+, which registers its\n                 * v3 token submission filter there - are never initialised.\n                 *\n                 * Dispatching unconditionally is not safe. 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novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcJxVwqAAAAAEeC_gQh0-IegF3B6JFamOBAu2Vs' data-tabindex='0'><input id=\"input_71a5fc995633197e127fa6d029812193\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_71a5fc995633197e127fa6d029812193\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_4' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>10<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_10' style='width:10%;'><span>10%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_4_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_42\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Personal Information - Employee<\/h3><div class='gsection_description' id='gfield_description_4_42'>Please confirm your information to proceed with benefits election.<\/div><\/div><div id=\"field_4_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_2'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_4_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_1'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_4_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_64\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_64' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_64_1_container' >\n                                        <input type='text' name='input_64.1' id='input_4_64_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_64_1' id='input_4_64_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_64_2_container' >\n                                        <input type='text' name='input_64.2' id='input_4_64_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_64_2' id='input_4_64_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_64_3_container' >\n                                    <input type='text' name='input_64.3' id='input_4_64_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_64_3' id='input_4_64_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_4_64_4_container' >\n                                        <select name='input_64.4' id='input_4_64_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_4_64_4' id='input_4_64_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_64_5_container' >\n                                    <input type='text' name='input_64.5' id='input_4_64_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_64_5' id='input_4_64_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_64.6' id='input_4_64_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_4_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_4_5' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_7'>SSN<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_4_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_8\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_8'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_8' id='input_4_8' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_8_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_8_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_8' class='gform_hidden' value='https:\/\/b6benefits.com\/ziggis\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_4_41' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_2' class='gform_page' data-js='page-field-id-41' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Are you a Tobacco User?<\/h3><div class='gsection_description' id='gfield_description_4_44'>Please signify if you have used tobacco in the last 12 Months<\/div><\/div><fieldset id=\"field_4_6\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Tobacco User<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_6'><div class='gchoice gchoice_4_6_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='Yes'  id='choice_4_6_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_6_1' id='label_4_6_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_6_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.2' type='checkbox'  value='No'  id='choice_4_6_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_6_2' id='label_4_6_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_45' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_45' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_3' class='gform_page' data-js='page-field-id-45' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Dependents<\/h3><div class='gsection_description' id='gfield_description_4_47'>Please signify if you have dependents<\/div><\/div><fieldset id=\"field_4_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have dependents?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_79'>\n\t\t\t<div class='gchoice gchoice_4_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_4_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_79_0' id='label_4_79_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No'  id='choice_4_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_79_1' id='label_4_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_40\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Dependent One - Information<\/h3><\/div><div id=\"field_4_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_10'>Dependent 1 Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_4_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_66\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_66'>Dependent 1 Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_66' id='input_4_66' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_66_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_66_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_66' class='gform_hidden' value='https:\/\/b6benefits.com\/ziggis\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_4_9\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_9'>Dependent 1 Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_4_9' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/div><div id=\"field_4_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_12'>Dependent 1 Relation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_4_12' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Spouse' >Spouse<\/option><option value='Significant Other' >Significant Other<\/option><option value='Child' >Child<\/option><option value='Step-Child' >Step-Child<\/option><option value='Grand-Child' >Grand-Child<\/option><option value='Nephew\/Niece' >Nephew\/Niece<\/option><option value='Mother' >Mother<\/option><option value='Father' >Father<\/option><\/select><\/div><\/div><fieldset id=\"field_4_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have a second dependent?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_52'>\n\t\t\t<div class='gchoice gchoice_4_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Yes'  id='choice_4_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_52_0' id='label_4_52_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='No'  id='choice_4_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_52_1' id='label_4_52_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Dependent Two - Information<\/h3><\/div><div id=\"field_4_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_14'>Dependent 2 Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_4_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_67\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_67'>Dependent 2 Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_67' id='input_4_67' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_67_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_67_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_67' class='gform_hidden' value='https:\/\/b6benefits.com\/ziggis\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_4_13\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_13'>Dependent 2 Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_4_13' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/div><div id=\"field_4_16\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_16'>Dependent 2 Relation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_4_16' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Spouse' >Spouse<\/option><option value='Significant Other' >Significant Other<\/option><option value='Child' >Child<\/option><option value='Step-Child' >Step-Child<\/option><option value='Grand-Child' >Grand-Child<\/option><option value='Nephew\/Niece' >Nephew\/Niece<\/option><option value='Mother' >Mother<\/option><option value='Father' >Father<\/option><\/select><\/div><\/div><fieldset id=\"field_4_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have a third dependent?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_54'>\n\t\t\t<div class='gchoice gchoice_4_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Yes'  id='choice_4_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_54_0' id='label_4_54_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='No'  id='choice_4_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_54_1' id='label_4_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Dependent Three - Information<\/h3><\/div><div id=\"field_4_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_18'>Dependent 3 Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_4_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_68\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_68'>Dependent 3 Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_68' id='input_4_68' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_68_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_68_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_68' class='gform_hidden' value='https:\/\/b6benefits.com\/ziggis\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_4_17\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_17'>Dependent 3 Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_4_17' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/div><div id=\"field_4_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_20'>Dependent 3 Relation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_4_20' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Spouse' >Spouse<\/option><option value='Significant Other' >Significant Other<\/option><option value='Child' >Child<\/option><option value='Step-Child' >Step-Child<\/option><option value='Grand-Child' >Grand-Child<\/option><option value='Nephew\/Niece' >Nephew\/Niece<\/option><option value='Mother' >Mother<\/option><option value='Father' >Father<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_55' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_55' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_4' class='gform_page' data-js='page-field-id-55' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_58\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Beneficiary - Information<\/h3><\/div><div id=\"field_4_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_22'>Beneficiary Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_4_22' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_24\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_24'>Beneficiary Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_24' id='input_4_24' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_24_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_24_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_24' class='gform_hidden' value='https:\/\/b6benefits.com\/ziggis\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_4_21\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_21'>Beneficiary Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_4_21' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/div><div id=\"field_4_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_23'>Beneficiary Relation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_4_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Spouse' >Spouse<\/option><option value='Significant Other' >Significant Other<\/option><option value='Child' >Child<\/option><option value='Step-Child' >Step-Child<\/option><option value='Grand-Child' >Grand-Child<\/option><option value='Nephew\/Niece' >Nephew\/Niece<\/option><option value='Mother' >Mother<\/option><option value='Father' >Father<\/option><option value='Sibling' >Sibling<\/option><option value='Step-Sibling' >Step-Sibling<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_59' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_59' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_5' class='gform_page' data-js='page-field-id-59' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Hospital Indemnity<\/h3><\/div><fieldset id=\"field_4_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Hospital<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_27'>\n\t\t\t<div class='gchoice gchoice_4_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Employee'  id='choice_4_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_27_0' id='label_4_27_0' class='gform-field-label gform-field-label--type-inline'>Employee<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Employee and Spouse'  id='choice_4_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_27_1' id='label_4_27_1' class='gform-field-label gform-field-label--type-inline'>Employee and Spouse<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Employee and Child'  id='choice_4_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_27_2' id='label_4_27_2' class='gform-field-label gform-field-label--type-inline'>Employee and Child<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Family'  id='choice_4_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_27_3' id='label_4_27_3' class='gform-field-label gform-field-label--type-inline'>Family<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_25\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Click to Waive Hospital<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_25'><div class='gchoice gchoice_4_25_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.1' type='checkbox'  value='Waive'  id='choice_4_25_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_25_1' id='label_4_25_1' class='gform-field-label gform-field-label--type-inline'>Waive<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_60' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_60' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_6' class='gform_page' data-js='page-field-id-60' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Accident Insurance<\/h3><\/div><fieldset id=\"field_4_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Accident<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_28'>\n\t\t\t<div class='gchoice gchoice_4_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Employee'  id='choice_4_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_28_0' id='label_4_28_0' class='gform-field-label gform-field-label--type-inline'>Employee<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Employee and Spouse'  id='choice_4_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_28_1' id='label_4_28_1' class='gform-field-label gform-field-label--type-inline'>Employee and Spouse<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Employee and Child'  id='choice_4_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_28_2' id='label_4_28_2' class='gform-field-label gform-field-label--type-inline'>Employee and Child<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Family'  id='choice_4_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_28_3' id='label_4_28_3' class='gform-field-label gform-field-label--type-inline'>Family<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Click to Waive Accident<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_26'><div class='gchoice gchoice_4_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Waive'  id='choice_4_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_26_1' id='label_4_26_1' class='gform-field-label gform-field-label--type-inline'>Waive<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_62' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_62' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_7' class='gform_page' data-js='page-field-id-62' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_70\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Medical Plans - MEC3, MEC4 + IHP<\/h3><\/div><fieldset id=\"field_4_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >MEC3<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_31'>\n\t\t\t<div class='gchoice gchoice_4_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Employee'  id='choice_4_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_31_0' id='label_4_31_0' class='gform-field-label gform-field-label--type-inline'>Employee<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Employee and Spouse'  id='choice_4_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_31_1' id='label_4_31_1' class='gform-field-label gform-field-label--type-inline'>Employee and Spouse<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Employee and Child'  id='choice_4_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_31_2' id='label_4_31_2' class='gform-field-label gform-field-label--type-inline'>Employee and Child<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_31_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Family'  id='choice_4_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_31_3' id='label_4_31_3' class='gform-field-label gform-field-label--type-inline'>Family<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Click to Waive MEC3<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_29'><div class='gchoice gchoice_4_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Waive'  id='choice_4_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_29_1' id='label_4_29_1' class='gform-field-label gform-field-label--type-inline'>Waive<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_38\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >MEC4<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_38'>\n\t\t\t<div class='gchoice gchoice_4_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Employee'  id='choice_4_38_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_38_0' id='label_4_38_0' class='gform-field-label gform-field-label--type-inline'>Employee<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Employee and Spouse'  id='choice_4_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_38_1' id='label_4_38_1' class='gform-field-label gform-field-label--type-inline'>Employee and Spouse<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_38_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Employee and Child'  id='choice_4_38_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_38_2' id='label_4_38_2' class='gform-field-label gform-field-label--type-inline'>Employee and Child<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_38_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Family'  id='choice_4_38_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_38_3' id='label_4_38_3' class='gform-field-label gform-field-label--type-inline'>Family<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_37\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Click to Waive MEC4<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_37'><div class='gchoice gchoice_4_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='Waive'  id='choice_4_37_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_37_1' id='label_4_37_1' class='gform-field-label gform-field-label--type-inline'>Waive<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_69' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_69' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_8' class='gform_page' data-js='page-field-id-69' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_4_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Whole Life Insurance<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_33'>\n\t\t\t<div class='gchoice gchoice_4_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Employee'  id='choice_4_33_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_33_0' id='label_4_33_0' class='gform-field-label gform-field-label--type-inline'>Employee<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_32\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_32'>WL Amount<\/label><div class='ginput_container ginput_container_select'><select name='input_32' id='input_4_32' class='large gfield_select'     aria-invalid=\"false\" ><option value='$5,000' >$5,000<\/option><option value='$10,000' >$10,000<\/option><option value='$15,000' >$15,000<\/option><option value='$20,000' >$20,000<\/option><option value='$50,000' >$50,000<\/option><option value='$100,000' >$100,000<\/option><\/select><\/div><\/div><fieldset id=\"field_4_30\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Click to Waive Whole Life<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_30'><div class='gchoice gchoice_4_30_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.1' type='checkbox'  value='Waive'  id='choice_4_30_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_30_1' id='label_4_30_1' class='gform-field-label gform-field-label--type-inline'>Waive<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_72' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_72' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_9' class='gform_page' data-js='page-field-id-72' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_4_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Disability<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_36'>\n\t\t\t<div class='gchoice gchoice_4_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Employee'  id='choice_4_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_36_0' id='label_4_36_0' class='gform-field-label gform-field-label--type-inline'>Employee<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_34\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_34'>DI Amt<\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_4_34' class='large gfield_select'     aria-invalid=\"false\" ><option value='$100' >$100<\/option><option value='$150' >$150<\/option><option value='$200' >$200<\/option><option value='$250' >$250<\/option><option value='$300' >$300<\/option><option value='$350' >$350<\/option><option value='$400' >$400<\/option><option value='$450' >$450<\/option><option value='$500' >$500<\/option><option value='$550' >$550<\/option><option value='$600' >$600<\/option><option value='$650' >$650<\/option><option value='$700' >$700<\/option><option value='$750' >$750<\/option><option value='$800' >$800<\/option><option value='$850' >$850<\/option><option value='$900' >$900<\/option><option value='$950' >$950<\/option><option value='$1000' >$1000<\/option><\/select><\/div><\/div><fieldset id=\"field_4_35\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Click to Waive Disability<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_35'><div class='gchoice gchoice_4_35_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.1' type='checkbox'  value='Waive'  id='choice_4_35_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_35_1' id='label_4_35_1' class='gform-field-label gform-field-label--type-inline'>Waive<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_73' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_4_73' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_10' class='gform_page' data-js='page-field-id-73' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_10' class='gform_fields 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Please edit the form settings and turn off Legacy Markup.\",\"fieldCanBeAddedImageChoice\":\"You cannot add an Image Choice field to a form that uses legacy markup. Please edit the form settings and turn off Legacy Markup.\",\"FieldAjaxonErrorTitle\":\"Error\",\"StartAddFieldAjaxonError\":\"Ajax error while adding field. Please refresh the page and try again.\",\"StartChangeInputTypeAjaxonError\":\"Ajax error while changing input type. Please refresh the page and try again.\",\"MissingNameCustomChoicesTitle\":\"Missing Name\",\"MissingNameCustomChoices\":\"Please give this custom choice a name.\",\"DuplicateNameCustomChoicesTitle\":\"Duplicate Name\",\"DuplicateNameCustomChoices\":\"This custom choice name is already in use. Please enter another name.\",\"DuplicateTitleMessageTitle\":\"Duplicate Title\",\"DuplicateTitleMessage\":\"The form title you have entered is already taken. Please enter a unique form title.\",\"ValidateFormMissingFormTitleTitle\":\"Missing Form Title\",\"ValidateFormMissingFormTitle\":\"Please enter a Title for this form. When adding the form to a page or post, you will have the option to hide the title.\",\"ValidateFormEmptyPageTitle\":\"Empty Page\",\"ValidateFormEmptyPage\":\"This form currently has one or more pages without any fields. Blank pages are a result of Page Breaks that are positioned as the first or last field in the form or right after each other. Please adjust the Page Breaks.\",\"ValidateFormMissingProductLabelTitle\":\"Missing Product Label\",\"ValidateFormMissingProductLabel\":\"This form has a Product field with a blank label. Please enter a label for every Product field.\",\"ValidateFormMissingProductFieldTitle\":\"Missing Product field\",\"ValidateFormMissingProductField\":\"This form has an Option field without a Product field. You must add a Product field to your form.\",\"FormulaIsValidTitle\":\"Success\",\"FormulaIsValid\":\"The formula appears to be valid.\",\"FormulaIsInvalid\":\"There appears to be a problem with the formula.\",\"DeleteFormTitle\":\"Confirm\",\"DeleteForm\":\"You are about to move this form to the trash. &#039;Cancel&#039; to abort. &#039;OK&#039; to delete.\",\"DeleteCustomChoice\":\"Delete this custom choice list? &#039;Cancel&#039; to abort. &#039;OK&#039; to delete.\",\"FieldAdded\":\"&nbsp;field added to form\",\"nameFieldDefaultPrefixes\":[{\"text\":\"Dr.\",\"value\":\"Dr.\"},{\"text\":\"Miss\",\"value\":\"Miss\"},{\"text\":\"Mr.\",\"value\":\"Mr.\"},{\"text\":\"Mrs.\",\"value\":\"Mrs.\"},{\"text\":\"Ms.\",\"value\":\"Ms.\"},{\"text\":\"Mx.\",\"value\":\"Mx.\"},{\"text\":\"Prof.\",\"value\":\"Prof.\"},{\"text\":\"Rev.\",\"value\":\"Rev.\"}]};\t\t\t<\/script>\n\n            \t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-dce-background-overlay-image-url=\"https:\/\/b6benefits.com\/ziggis\/wp-content\/uploads\/2023\/01\/bg-07.png\" class=\"elementor-section elementor-top-section elementor-element elementor-element-083f769 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"083f769\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[],&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-0a02e56\" data-id=\"0a02e56\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2247944 elementor-widget__width-initial elementor-widget elementor-widget-gva-heading-block\" data-id=\"2247944\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"gva-heading-block.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"gva-element-gva-heading-block gva-element\">   <div class=\"align-left style-1 widget gsc-heading box-align-left auto-responsive\">\r\n      <div class=\"content-inner\">\r\n         \r\n                  \r\n         <div class=\"sub-title\"><span class=\"tagline\">Stay informed<\/span><\/div>  \r\n         \r\n                     <h2 class=\"title\">\r\n               <span>Benefits 101<\/span>\r\n            <\/h2>\r\n                  \r\n                     <div class=\"title-desc\">Have Benefit Questions? Reach out to your Benefit Advisor! Any questions or concerns are a call away. We will advocate for your claims, and more!<\/div>\r\n         \r\n         \r\n      <\/div>\r\n   <\/div>\r\n<\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-9c61a96\" data-id=\"9c61a96\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d539dad elementor-widget elementor-widget-heading\" data-id=\"d539dad\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Call us!<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c4e5d11 elementor-widget elementor-widget-heading\" data-id=\"c4e5d11\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">(515) 400 - 1011<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bda4035 elementor-widget elementor-widget-heading\" data-id=\"bda4035\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">or <b>email<\/b> at:<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-931b5bd elementor-widget elementor-widget-heading\" data-id=\"931b5bd\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">clientservices@3esuite.com<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>2026 Enroll in your Benefit Offers Easily enroll in your new benefits offered to you by Ziggi&#8217;s Coffee. Follow the instructions on the form below to continue. Step 1 of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_eb_attr":"","footnotes":""},"class_list":["post-484","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/pages\/484","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/comments?post=484"}],"version-history":[{"count":43,"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/pages\/484\/revisions"}],"predecessor-version":[{"id":1305,"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/pages\/484\/revisions\/1305"}],"wp:attachment":[{"href":"https:\/\/b6benefits.com\/ziggis\/wp-json\/wp\/v2\/media?parent=484"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}