.claim-main{width:min(980px,calc(100% - 32px))}.provider{display:grid;gap:5px;padding:20px;margin:25px 0;border-radius:12px;background:#07111d;color:#fff}.provider span{color:#bad0da;font-size:13px}fieldset{margin:28px 0;padding:25px;border:1px solid var(--line);border-radius:13px}legend{padding:0 9px;font-weight:900}.form-grid{display:grid;grid-template-columns:1fr 1fr;gap:15px}.form-grid .full{grid-column:1/-1}label{display:grid;gap:7px;color:var(--ink);font-size:13px;font-weight:800}input,select,textarea{width:100%;padding:13px;border:1px solid #cbd8de;border-radius:9px;font:inherit;background:#fff}textarea{resize:vertical}.inline{display:flex;align-items:flex-start;gap:9px;margin-top:13px;color:var(--muted);font-weight:500}.inline input{width:18px;height:18px;margin:0}.claim-type{display:grid;grid-template-columns:1fr 1fr;gap:14px;margin-bottom:18px}.claim-type label{position:relative}.claim-type input{position:absolute;opacity:0}.claim-type span{display:grid;gap:5px;padding:17px;border:1px solid var(--line);border-radius:10px;cursor:pointer}.claim-type input:checked+span{border-color:var(--blue);background:#e9f6fa}.claim-submit,.claim-receipt button{padding:15px 18px;border:0;border-radius:10px;background:#16cd70;color:#052516;font:800 15px Inter;cursor:pointer}.claim-status{font-weight:800}.claim-status.error{color:#b42318}.honeypot{position:absolute;left:-9999px}.claim-receipt{border-top:0;background:#f0faf4;border-radius:14px;padding:25px}.claim-receipt h2{font-size:30px}@media(max-width:650px){.form-grid,.claim-type{grid-template-columns:1fr}.form-grid .full{grid-column:auto}fieldset{padding:18px}}@media print{header,footer,#claim-form,.claim-main>p,.provider{display:none!important}.claim-main{box-shadow:none;border:0;margin:0;padding:0}.claim-receipt{display:block!important}}