Clearinghouse Opt Out Policy Number Entry
Clearinghouse Opt Out Form
Clearinghouse Opt Out Submission Confirmation
</div> <div class="main-content" style="display: none;" > <form action="" method="post"> <div class="RegistrationPage"> <div class="SectionBody" style="display: none;" id="sb_optout_sub"> <table id="policyinfosub" class="TableContainer"> <tbody> <tr class="control-row"> <td class="ItemValue"> <section class="row"> <article> <label><strong>Insured Name</strong></label> </article> <article> <span class="textarea"></span> </article> <article> <label><strong>Policy Number </strong></label><span></span> </article> </section> </td> </tr> <tr class="control-row"> <td class="ItemValue"> <section class="row"> <article><label><strong>Property Address</strong></label></article> <article> <span class="textarea"></span> </article> <article></article> </section> </td> </tr> <tr class="control-row"> <td class="ItemValue"> <section class="row"> <article><label><strong>Property City</strong></label></article> <article> <span class="textarea"></span> </article> <article></article> </section> </td> </tr> <tr class="control-row"> <td class="ItemValue"> <section class="row"> <article><label><strong>Property State</strong></label></article> <article> <span class="textarea"></span> </article> <article></article> </section> </td> </tr> <tr class="control-row"> <td class="ItemValue"> <section class="row"> <article><label><strong>ZIP Code</strong></label></article> <article> <span class="textarea"></span> </article> <article></article> </section> </td> </tr> </tbody> </table> <div> <label id="confirmtext">Please be advised that your Clearinghouse Opt‐Out Submission Request has been received and processed on <strong>6/28/2022</strong>. As such, your personal information will no longer be shared with ClearingHouse participating companies.</label> </div> <div id="restartbuttondiv" class="column"> <section class="row"> <input type="button" value="Print" id='printbutton' class="btn ui-button redButton" /> <input type="button" value="Done" id='cancelbutton1' class="btn ui-button redButton" /> </section> <a href="." id="lnktryanother">Click here to Opt-Out Another policy</a> </div> <div style="text-align:center; display:none;"> <span class="stamp">Received in Onbase on 6/28/2022</span> </div> </div> <div class="col-xs-10 SectionTitle" id="oupout_title" style="display: block;"> <p> Fair Plan (CFP) Policyholders, please enter your policy number to proceed to the Clearinghouse Opt Out Form. </p> <p style="display:none;"> This form is to be completed by California Fair Plan (CFP) Policyholders, who do not want the CFP to share their personal information with Clearinghouse participating companies. </p> </div> <div class="col-xs-10 SectionBody" id="sb_plcsrch" style="display: block;"> <div class="row"> <span><strong>Policy Number</strong></span> <section> <span class="prefix"><input name="txblob" type="text" maxlength="3" id="txblob1" tabindex="10" class="textBox" value="CFP" readonly /></span> <input name="txtPolicyNumberSrch" type="text" maxlength="7" id="txtPolicyNumberSrch" tabindex="11" class="textBox" /> </section> <input type="button" value="Enter" id='searchpolicybutton' class="btn ui-button redButton" disabled /> </div> <div id="divRecaptcha" class="row"> <div id="grcpt_input"></div> <input type="text" id="hResp" name="hResp" value="" hidden="hidden" /> </div> <div class="row"><label id="lblmsg" style="display: none; color: red;"></label></div> </div> <div class="SectionBody" style="display: none;" id="sb_policyinfo"> <table id="policyinfo" class="TableContainer"> <tbody> <tr class="control-row"> <td class="ItemName"> <span><strong>Policy Number</strong></span> </td> <td class="ItemValue"> <span class="prefix"><input name="txblob" type="text" maxlength="3" id="txblob" tabindex="10" class="textBox" databind="Model.lob" value="CFP" readonly /></span> <input name="txtPolicyNumber" type="text" maxlength="7" id="txtPolicyNumber" tabindex="11" class="textBox" databind="Model.policyno" value="" required /> </td> </tr> <tr class="control-row"> <td class="ItemName"> <span><strong>Insured Name</strong> <span class="reqspan"> * </span></span> </td> <td class="ItemValue"> <input name="txtInsuedName" type="text" id="txtInsuedName" tabindex="11" class="textBox" databind="Model.OptOutInsuredName" value="" required /> </td> </tr> <tr class="control-row"> <td class="ItemName"> <span><strong>Property Address</strong><span class="reqspan"> * </span></span> </td> <td class="ItemValue"> <input name="txtPropertyAddress" type="text" id="txtPropertyAddress" tabindex="12" class="textBox" databind="Model.RiskAddress" value="" required /> </td> </tr> <tr class="control-row"> <td class="ItemName"> <span><strong>Property City</strong><span class="reqspan"> * </span></span> </td> <td class="ItemValue"> <input name="txtPropertyCity" type="text" id="txtPropertyCity" tabindex="13" class="textBox" databind="Model.RiskCity" value="" required /> </td> </tr> <tr class="control-row"> <td class="ItemName"> <span><strong>Property State</strong><span class="reqspan"> * </span></span> </td> <td class="ItemValue"> <input name="txtPropertyState" type="text" id="txtPropertyState" tabindex="14" maxlength="2" class="textBox" databind="Model.RiskState" value="" required /> </td> </tr> <tr class="control-row"> <td class="ItemName"> <span><strong>ZIP Code</strong> (5-digit)<span class="reqspan"> * </span></span> </td> <td class="ItemValue"> <span class="prefix"></span> <input name="txtPropertyAddressZip" type="text" maxlength="5" id="txtPropertyAddressZip" tabindex="15" class="textBox" databind="Model.RiskZip" value="" required /> </td> </tr> <tr> <td colspan="2"> <span id="disclaimerop"> By submitting this Clearinghouse opt‐out submission request to the CFP, I hereby confirm that I am the named insured on the policy. </span> </td> </tr> <tr> <td colspan="2"> <p class="check_section"> <input name="chkoptout" type="checkbox" databind="Model.xopt_out" id="chkoptout" class="regular-checkbox big-checkbox" /> <label for="chkoptout" class="lblchks"></label> <label for="chkoptout" class="lbltxt">Check here to Opt-Out of Clearinghouse</label> </p> </td> </tr> <tr class="control-row"> <td colspan="2"> <label id="lblmsg1" style="display: none; color: red;"></label> </td> </tr> <tr class="control-row"> <td colspan="2"> <div id="submitbuttondiv"> <input type="submit" value="Submit" id='submitbutton' class="btn ui-button redButton" /> <input type="button" value="Cancel" id='cancelbutton' class="btn ui-button redButton" /> </div> </td> </tr> </tbody> </table> </div> </div> </form> <script> $(function () { $('#searchpolicybutton').click(function () { if ($('#txtPolicyNumberSrch').val().length <= 0) return; searchPlcy(); }); $('#txtPolicyNumberSrch').change(function () { var regex = /(^\d{1,}$)/; if (!$('#txtPolicyNumberSrch').val().match(regex)) { var plcyno_entered = $('#txtPolicyNumberSrch').val(); var llen = plcyno_entered.length; return false; } }); $('table#policyinfo input[id^="txt"').on("input", function () { if ($(this).val().length > 0) { $(this).val($(this).val().toUpperCase()); var thistxtid = $(this).prop('id'); if (checkallrequiredfieldsfilled() == true && checkPolicyZipMatch()) { $('.check_section').show(); } else { disableclicksubmit(); } } else { disableclicksubmit(); } }); $('#cancelbutton').click(function () { var urlto = "https://www.cfpnet.com"; location.href = urlto; }); $('#cancelbutton1').click(function () { var urlto = "https://www.cfpnet.com"; location.href = urlto; }); $('#submitbutton').click(function () { var regex = /(^\d{5}$)/; if (!$('#txtPropertyAddressZip').val().match(regex)) { $('#lblmsg1').text("Property Zip Code has to be a 5-digit number"); $('#lblmsg1').show(); return false; } }); $('input[name="chkoptout"]').change(function () { if ($(this).prop('checked') == true && checkallrequiredfieldsfilled() == true) { $('#submitbutton').show(); } else { $('#submitbutton').hide(); } }); //submitted section $('#printbutton').click(function () { window.print(); }); }); if (location.href.indexOf('localhost') > 0) { $("#divRecaptcha").hide(); //$('#searchpolicybutton').show(); $('#searchpolicybutton').prop('disabled', false); } var cfpCaptcha; function getrcp() { if (location.href.indexOf('localhost') > 0) { $("#divRecaptcha").hide(); //$('#searchpolicybutton').show(); $('#searchpolicybutton').prop('disabled', false); return; } $.ajax({ type: "GET", url: 'api/recaptcha/get', async: false, dataType: "json", success: function (data) { var sitekey = data.ElementSiteKey; var stoken = data.ElementSToken; $('#hResp').attr('datatoken', stoken); if (grecaptcha) { cfpCaptcha = grecaptcha.render('grcpt_input', { 'sitekey': sitekey, 'data-stoken': stoken, // optional 'theme': 'light', // optional //'data-size': compact, 'callback': function (response) { $('#hResp').val(response); $.ajax({ type: "POST", url: "api/recaptcha/VerifyCaptcha", data: "{response: '" + response + "'}", contentType: "application/json; charset=utf-8", dataType: "json", success: function (r) { console.log(JSON.stringify(r)); var captchaResponse = jQuery.parseJSON(r.response); if (captchaResponse) { //$("#hfCaptcha").val(captchaResponse.success); //$("#divRecaptcha").hide(); //$('#searchpolicybutton').show(); $('#searchpolicybutton').prop('disabled', false); } else { $("##hResp").val(""); $("#divRecaptcha").show(); $('#searchpolicybutton').prop('disabled', true); //var error = captchaResponse["error-codes"][0]; //$("#rfvCaptcha").html("RECaptcha error. " + error); } } }); } }); } }, error: function (xhr, ajaxOptions, thrownError) { if (grecaptcha) { cfpCaptcha = grecaptcha.render('grcpt_input', { 'sitekey': '6LdDFRgTAAAAABDEwF0ERwj40KXLyrU0oJhIGWDm', 'theme': 'light', // optional 'callback': function (response) { $('#hResp').val(response); } }); } //alert("reCaptcha can't be loaded."); } }); } function checkallrequiredfieldsfilled() { var alltxtfilled = 0; var alltxtrequcount = 0; $.each($('table#policyinfo input[id^="txt"'), function (key, value) { if ($(this).prop('required') == true) alltxtfilled++; if ($(this).prop('required') == true && $(this).val().length > 0) alltxtrequcount++; }); console.log(alltxtfilled.toString() + " vs " + alltxtrequcount.toString()); if (alltxtfilled > 0 && alltxtrequcount > 0 && alltxtrequcount == alltxtfilled) return true; return false; } function searchPlcy() { var regex = /(^\d{7}$)/; if (!$('#txtPolicyNumberSrch').val().match(regex)) { $('#lblmsg').text("Policy Number must be a 7-digit number"); $('#lblmsg').show(); grecaptcha.reset(); $('#searchpolicybutton').prop('disabled', true); return; } $('#spinner').hide(); var entered_plcy = $('#txtPolicyNumberSrch').val(); var senddata = { policyno: entered_plcy }; $.get("api/policysearch/Get", senddata, function (data, status) { //console.log(JSON.stringify(data)); if (data && data.length > 0) { var curstate = ""; for (var i = 0; i < data.length; i++) { if (data[i].xopt_out && data[i].xopt_out == true) { var alerttext = 'You have selected to Opt-Out for your Policy CFP-' + data[i].policyno + ". Please try another policy."; $('#lblmsg').text(alerttext); $('#lblmsg').show(); $('#spinner').hide(); grecaptcha.reset(); $('#searchpolicybutton').prop('disabled', true); return; } curstate = data[i].riskstate; } $('#lblmsg').hide(); $('#sb_plcsrch').hide(); $('#oupout_title p:first-child').hide(); $('#sb_policyinfo').show(); $('#oupout_title p:last-child').show(); $('#subheading1').hide(); $('#subheading2').show(); $('#subheading3').hide(); $('#txtPolicyNumber').val($('#txtPolicyNumberSrch').val()); $('#txtPolicyNumber').prop('readonly', true); $('#txtPropertyState').val(curstate); $('#txtPropertyState').prop('readonly', true); $('#submitbutton').hide(); } else { $('#lblmsg').text('Policy CFP-' + entered_plcy + " not found."); $('#lblmsg').css('display', 'block'); grecaptcha.reset(); $('#searchpolicybutton').prop('disabled', true); } $('#spinner').hide(); }); } function checkPolicyZipMatch() { var zregex = /(^\d{5}$)/; var pregex = /(^\d{7}$)/; $('#lblmsg1').hide(); var pol = $('#txtPolicyNumber').val(); var z = $('#txtPropertyAddressZip').val(); if (!z.match(zregex) || !pol.match(pregex)) { return false; } var senddata = { policyno: pol, propzip: z }; $.get("api/PolicyZip/Get", senddata, function (data, status) { console.log(JSON.stringify(data)); if (data && data.length > 0) { var curstate = ""; for (var i = 0; i < data.length; i++) { if (data[i].policyno && data[i].policyno.length > 0 && data[i].propzip && data[i].propzip.length > 0) { if (checkallrequiredfieldsfilled() == true) { $('.check_section').show(); } return true; } } } disableclicksubmit(); $('#lblmsg1').text("Zip Code Must Match Property Zip Code on Policy."); $('#lblmsg1').show(); return false; }); } function disableclicksubmit() { $('input[name="chkoptout"]').prop('checked', false); $('.check_section').hide(); $('#submitbutton').hide(); } </script> <script type="text/javascript"> var searchres = 1; if (searchres > 0) { //$("#sb_policyin").css('display', 'none'); var poores = {"policyno":"","OptOutInsuredName":"","usrRiskAddress":"","usrRiskCity":"","usrRiskState":"","usrRiskZip":"","xopt_out":false,"submitdatetime":"\/Date(1656451080000)\/"}; console.log(JSON.stringify(poores)); var plcyno_ret = ""; if (poores) { for (property in poores) { if (property == 'policyno' && poores[property] == null) { //console.log('key= ${' + property + '} value = ${' + poores[property] + '}'); break; } else if (property == 'policyno') { plcyno_ret = poores[property]; } } if (plcyno_ret.length > 0) { $('#oupout_title').hide(); $('#sb_plcsrch').hide(); $('#sb_policyinfo').hide(); $('#subheading1').hide(); $('#subheading2').hide(); $('#subheading3').show(); $('#sb_optout_sub').show(); } } } </script> <div id="spinner" style="display: none; margin-left: auto; margin-right: auto; text-align: center"> <div class="loadingio-spinner-spinner-em5y7qh7k5p"> <div class="ldio-wfdbp4y5cbl"> <div></div> <div></div> <div></div> <div></div> <div></div> <div></div> <div></div> <div></div> <div></div> <div></div> <div></div> <div></div> </div> </div> </div> <style type="text/css"> @keyframes ldio-wfdbp4y5cbl { 0% { opacity: 1 } 100% { opacity: 0 } } .ldio-wfdbp4y5cbl div { left: 94px; 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