New Employer Setup

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

General Information

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

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

<%= f.text_field :pl_plan_key, label: { text: "Pl Plan Key" }, 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" }, class: "w-full" %>

Choose Employer Logo File No file chosen <%= f.file_field :employer_logo, class: "hidden", id: "file_upload_input" %>

Plans Information

<% @employer_setup.plans.each_with_index do |plan, index| %> <%= f.fields_for :plans, plan, child_index: index do |plan_fields| %> <% if index == 0 %>

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

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

<%= plan_fields.fields_for :plan_benefits do |plan_benefits_fields| %>

<%= render 'plan_benefits_desc_fields', plan_benefits_fields: plan_benefits_fields %>

<%= render 'plan_benefit_only_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" } %>

<% else %>

-ml-[6px] z-2 w-full"> <%= "Plan #{index + 1}" %>

<%= render 'plan_fields', plan_fields: plan_fields, f: f, index: index %> <%= 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 #{index + 1}", class: "cursor-pointer bg-deepcove text-brightlava py-2 px-4 font-semibold leading-tight rounded border-3 border-#{EmployerSetupPlansForm::PLAN_COLORS[index]} w-full", data: { action: "add-plan#remove" } %>

<% end %> <% end %> <% 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-75 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" %>

<% end %>