New Employer

<%= form_with model: @employer_setup, url: import_employer_setup_index_path, data: { turbo: false }, local: true, multipart: true do |form| %>

<%= form.label :import_from_word, 'ID Card Setup Word Doc', class: "block text-platinum font-bold mb-1 md:mb-0 pr-4" %> <%= form.file_field :import_from_word %>

<%= form.submit "Import" %>

<% end %>

<%= form_with model: @employer_setup, url: employer_setup_index_path, local: true, multipart: true do |f| %>

General Information

<%= f.text_field :employer_name, label: { text: "Employer Name" }, data: { logo_upload_target: "employer" }, class: "w-full" %>

<%= f.text_field :group_number, label: { text: "Group/Medical Number" }, class: "w-full" %>

<%= f.text_field :effective_date, label: { text: "Effective Date" }, class: "w-full" %>

<%= f.select :network_provider, options_for_select(["Cigna", "Medcost"]), label: { text: "Provider Network" }, data: { logo_upload_target: "network" }, class: "w-full" %>

<%= f.text_field :employer_logo, value: "No logo added", data: { logo_upload_target: "logofield" }, class: "w-full rounded-r-none", readonly: true %>

<%= icon "image-plus", library: "lucide" %>

<%= f.file_field :add_or_update_logo, class: "hidden", id: "file_upload_input_employer", data: { logo_upload_target: "previewContainer", logo_upload_type_param: "employer", action: "change->logo-upload#uploadLogo" }, direct_upload: true %>

Plans Information

<%= f.fields_for :plans, @employer_setup.plans.first, child_index: 0 do |plan_fields| %>

-ml-[6px] z-2 w-full"> <%= "Plan 1" %>

<%= render 'plan_fields', plan_fields: plan_fields, f: f, index: 0 %>

"> Benefit Values

<%= plan_fields.fields_for :plan_benefits do |plan_benefits_fields| %> <%= render 'plan_benefits_fields', plan_benefits_fields: plan_benefits_fields %> <% end %>

<%= plan_fields.hidden_field :_destroy %> <%= button_tag "Remove Plan 1", class: "cursor-pointer bg-deepcove hover:bg-brightlava text-xl font-bold text-copper hover:text-platinum py-2 px-4 font-semibold leading-tight rounded-lg border-3 border-copper w-full", data: { action: "add-plan#remove" } %>

<% end %> <%= button_tag "Add a Plan", class: "cursor-pointer text-2xl font-bold py-2 pr-6 mt-10 w-[calc(24%-1rem)] w-1/4 min-h-[940px] text-[#E0E0E0] rounded-lg font-medium border border-[#E0E0E0] bg-[#173057] hover:bg-transparent hover:shadow-[0_0_10px_3px_#93c5fd] transition-colors duration-150", data: { action: "add-plan#add", add_plan_target: "button" } %>

Alternative Network Information

<%= button_tag "Add a Regional Logo", class: "cursor-pointer text-lg font-medium py-2 px-4 rounded w-1/7 h-55 my-8 text-[#E0E0E0] rounded-lg border border-[#C2C2C2] hover:shadow-[0_0_10px_3px_#93c5fd]", data: { action: "add-alt-network-logo#add", add_alt_network_logo_target: "button" } %>

<%= f.submit "Submit" %>