Texas Health Steps Form ENG

Value Added Service | Texas Health Steps

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

Cook Children’s Health Plan cares about the health of your child. We want to make sure your child gets the checkups she or she needs for proper growth and development.

Your child can be eligible for one of these rewards:

One $25 gift card for members ages 2 to 20 who complete an annual Texas Health Steps checkup (STAR and STAR Kids only)
OR
A $25 gift card for members who complete a Texas Health Steps checkup at 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, and 18 months of age ($25 gift card for each visit, maximum $200)

Cook Children’s Health Plan will check to see that the visit took place.

*Date of service must be within the current state fiscal year (September 1, 2026 - August 31, 2027)
Member name:
By filling out this form, you attest that the person above has completed their annual well checkup visit
Member ID number:
Member date of birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Provider name:
(first and last name)
Date of visit:

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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