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Peach-background coverage estimator with four underline dropdowns and a pill CTA to check out-of-pocket costs before first session.
Summary
A centered insurance eligibility form on solid peach, asking company, deductible, state, and email before checking coverage.
Visual description
Solid warm peach background with centered form block. Serif heading "See what you'll pay" and sans-serif paragraph explaining estimates versus full eligibility checks. Four fields use all-caps labels with asterisks: insurance company dropdown, annual deductible under $1500 dropdown with helper text in parentheses, state dropdown, and email with placeholder. White pill button "CHECK MY COVERAGE" with subtle shadow sits below the stack. Inputs are single underline lines without boxes.
Key takeaway
Pairing transparency copy with a short form reduces anxiety about surprise bills. Underline-only inputs on a flat color field feel premium and uncluttered.
Reuse notes
Built for healthcare pricing transparency. Requires backend eligibility logic; helper text under deductible question adds trust without extra fields.
