.EhiHeaderFooter_EhiFooter__disclaimer__G2iJJ{color:white;font-size:12px;line-height:16px}.EhiHeaderFooter_EhiFooter__disclaimer__G2iJJ p{margin-bottom:10px}.EhiHeaderFooter_EhiFooter__disclaimer__G2iJJ p a{color:var(--ehi-color-icon-primary);font-weight:700}.EhiHeaderFooter_EhiFooter__disclaimer__G2iJJ p a:hover{text-decoration:underline}.Form_error__sD4XV{margin-top:.25rem;margin-bottom:.25rem;display:flex;align-items:center;column-gap:.25rem;font-family:var(--ehi-font-poppins);font-size:12px;line-height:16px;color:var(--ehi-color-text-error)}@media (min-width:768px){.Form_error__sD4XV{margin-bottom:0}}.Form_error__sD4XV{svg{height:12px;width:12px}}.Form_input_error__0RB5A{border-color:var(--ehi-color-border-error)!important}.Form_input_error__0RB5A:focus{border-width:2px!important;border-color:var(--ehi-color-border-error)!important;outline:2px solid transparent!important;outline-offset:2px!important}.Form_input_label__ekg3D{margin-right:.25rem;margin-bottom:2px;display:flex;width:max-content;font-family:var(--ehi-font-poppins);font-size:14px;line-height:18px;color:var(--ehi-color-text-primary-dark)}@media (min-width:992px){.Form_label_small__mRAOt{display:none}}.Form_label_full__6ms8x{display:none}@media (min-width:992px){.Form_label_full__6ms8x{display:flex}}.Form_smb-wrapper__Hha21{margin-top:.5rem;display:flex;width:100%;flex-direction:column;gap:0}@media (min-width:768px){.Form_smb-wrapper__Hha21{margin-top:1rem;flex-direction:row;align-items:flex-start;gap:1rem}}.Form_smb-wrapper__Hha21{.Form_form_fields___EhVO{display:flex;width:100%}@media (min-width:768px){.Form_form_fields___EhVO{max-width:282px}}.Form_form_fields___EhVO{.Form_field__xWzpb{height:94px;width:100%}.Form_field__xWzpb[data-field-name=county]{margin-left:1rem}input,select{border-width:1px;border-color:var(--ehi-color-border-enabled);font-size:16px}}button{width:100%}@media (min-width:768px){button{margin-top:20px;min-width:245px}}@media (min-width:992px){button{width:282px}}}.Form_ifp_ps-wrapper__NnwEQ{margin-top:.5rem;display:flex;width:100%;flex-direction:column}@media (min-width:768px){.Form_ifp_ps-wrapper__NnwEQ{margin-top:1.5rem}}.Form_ifp_ps-wrapper__NnwEQ{.Form_form_fields___EhVO{margin-bottom:.5rem;display:grid;width:100%;grid-template-columns:repeat(2,minmax(0,1fr));column-gap:1rem}@media (min-width:768px){.Form_form_fields___EhVO{margin-bottom:0;grid-template-columns:repeat(12,minmax(0,1fr))}}@media (min-width:992px){.Form_form_fields___EhVO{max-width:690px}}.Form_form_fields___EhVO{.Form_field__xWzpb{height:fit-content;min-height:82px;outline:2px solid transparent;outline-offset:2px;outline-offset:0}@media (min-width:768px){.Form_field__xWzpb{height:90px}}.Form_field__xWzpb>input,.Form_field__xWzpb>select{border-width:1px;border-color:var(--ehi-color-border-enabled);font-size:16px;outline:2px solid transparent;outline-offset:2px;outline-offset:0}.Form_field__xWzpb>div{border-width:1px;border-color:var(--ehi-color-border-enabled);border-color:var(--ehi-color-border-disabled);font-size:16px;outline:2px solid transparent;outline-offset:2px;outline-offset:0}}.Form_form_fields___EhVO:has(>:nth-child(4):last-child){.Form_field__xWzpb[data-field-name=dateOfBirth],.Form_field__xWzpb[data-field-name=zipCode]{grid-column:span 12/span 12;width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=dateOfBirth],.Form_field__xWzpb[data-field-name=zipCode]{grid-column:span 6/span 6}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=dateOfBirth],.Form_field__xWzpb[data-field-name=zipCode]{grid-column:span 4/span 4}}.Form_field__xWzpb[data-field-name=sex],.Form_field__xWzpb[data-field-name=tobaccoUsage]{grid-column:span 12/span 12;width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=sex],.Form_field__xWzpb[data-field-name=tobaccoUsage]{grid-column:span 6/span 6}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=sex],.Form_field__xWzpb[data-field-name=tobaccoUsage]{grid-column:span 5/span 5}}}.Form_form_fields___EhVO:has(>:nth-child(5):last-child){.Form_field__xWzpb[data-field-name=dateOfBirth],.Form_field__xWzpb[data-field-name=zipCode]{grid-column:span 12/span 12;width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=dateOfBirth],.Form_field__xWzpb[data-field-name=zipCode]{grid-column:span 4/span 4}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=dateOfBirth],.Form_field__xWzpb[data-field-name=zipCode]{grid-column:span 3/span 3}}.Form_field__xWzpb[data-field-name=sex],.Form_field__xWzpb[data-field-name=tobaccoUsage]{grid-column:span 12/span 12;width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=sex],.Form_field__xWzpb[data-field-name=tobaccoUsage]{grid-column:span 6/span 6}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=sex],.Form_field__xWzpb[data-field-name=tobaccoUsage]{grid-column:span 5/span 5}}.Form_field__xWzpb[data-field-name=county]{grid-column:span 12/span 12;width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=county]{grid-column:span 4/span 4}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=county]{grid-column:span 5/span 5}}}button{width:100%}@media (min-width:992px){button{max-width:290px}}input[type=date][value=""]{color:var(--ehi-color-text-inactive)}}.Form_default-wrapper__dogMn{margin-top:.5rem;display:flex;width:100%;flex-direction:column}@media (min-width:768px){.Form_default-wrapper__dogMn{margin-top:1rem}}.Form_default-wrapper__dogMn{.Form_form_fields___EhVO{display:flex;width:100%;flex-direction:column;column-gap:1rem}@media (min-width:768px){.Form_form_fields___EhVO{flex-direction:row}}.Form_form_fields___EhVO{.Form_field__xWzpb{height:fit-content;min-height:90px}input,select{border-width:1px;border-color:var(--ehi-color-border-enabled);font-size:16px}}.Form_form_fields___EhVO:has(>:first-child:last-child){.Form_field__xWzpb[data-field-name=zipCode]{width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=zipCode]{max-width:340px}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=zipCode]{max-width:282px}}}.Form_form_fields___EhVO:has(>:nth-child(2):last-child){.Form_field__xWzpb[data-field-name=zipCode]{width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=zipCode]{max-width:210px}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=zipCode]{max-width:282px}}.Form_field__xWzpb[data-field-name=county]{width:100%}@media (min-width:768px){.Form_field__xWzpb[data-field-name=county]{max-width:210px}}@media (min-width:992px){.Form_field__xWzpb[data-field-name=county]{max-width:282px}}}button{width:100%}@media (min-width:768px){button{max-width:282px}}}.Form_rc-wrapper__USEXY{margin-top:.5rem;display:flex;width:100%;flex-direction:column;justify-content:center;padding-left:.5rem;padding-right:.5rem;font-weight:400}@media (min-width:768px){.Form_rc-wrapper__USEXY{height:94px;flex-direction:row}}.Form_rc-wrapper__USEXY{.Form_form_fields___EhVO{display:flex;flex-direction:column;gap:.5rem}@media (min-width:768px){.Form_form_fields___EhVO{flex-direction:row}}@media (min-width:992px){.Form_form_fields___EhVO{gap:.75rem}}.Form_field__xWzpb{width:100%}label{margin-right:.25rem;flex-shrink:1;font-family:var(--ehi-font-poppins);font-size:.875rem;line-height:1.25rem}input,select{height:50px;width:100%;border-radius:.25rem;border-width:1px;border-color:var(--ehi-color-border-enabled);background-color:var(--ehi-color-background-surface-light);padding:.75rem;font-size:16px}@media (min-width:768px){input,select{max-width:240px}}button{margin-top:22px;display:flex;height:50px;width:100%;align-items:center;justify-content:center;font-size:1.25rem}@media (min-width:768px){button{margin-left:.5rem;max-width:240px}}}.Form_rc-assistance-wrapper__OSuD5{display:flex;flex-direction:column;gap:1rem;.Form_form_fields___EhVO{display:flex;flex-direction:column;gap:1rem}input,select{height:50px;width:100%;border-radius:.25rem;border-width:1px;border-color:var(--ehi-color-border-enabled);background-color:var(--ehi-color-background-surface-light);padding:.75rem;font-size:16px}button{margin-bottom:24px;display:flex;height:50px;width:100%;align-items:center;justify-content:center;font-size:1.25rem}}.StickyComponent_component_wrapper__3L_a3{margin-top:0;position:fixed;left:0;right:0;z-index:20;transition:transform .3s ease-in-out;height:82px;background-color:var(--ehi-color-background-surface-light);transform:translateY(-100%)}@media (min-width:769px){.StickyComponent_component_wrapper__3L_a3{top:0;position:fixed;z-index:40;transform:translateY(-100%);box-shadow:0 2px 8px rgba(0,0,0,.1)}.StickyComponent_visible__Nhfxf{transform:translateY(0)}}@media (max-width:768px){.StickyComponent_component_wrapper__3L_a3{bottom:0;transform:translateY(100%);box-shadow:0 -2px 8px rgba(0,0,0,.1);border-top:1px solid #eee;padding-bottom:env(safe-area-inset-bottom,.75rem);height:76px;box-sizing:content-box}.StickyComponent_visible__Nhfxf{transform:translateY(0)}}