MyCookChildren's Form ENG

Value Added Service | MyCookChildren's

*Valid September 1, 2026 to August 31, 2027
Dear Cook Children’s Health Plan Member,

Cook Children’s Health Plan would like to send you a $20 gift card for activating your MyCookChildren’s account when completing the new initial Member Health Needs Assessment Screening.

*Date of service must be within the current state fiscal year (September 1, 2026 - August 31, 2027)
Member name (first and last name):
Member ID number:
Member DOB:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Date of activation:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Please remember to register or log in to Healthmine to access your digital gift card and rewards.

Some limitations and restrictions may apply. Member must be active both on the date of service and on the date of request. If you have any questions please visit our website www.cookchp.org, contact us through the MyCookChildren’s Member Portal or call Member Services at 1-800-964-2247.
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