Health Plan MyChart Access

Please complete the following request form to electronically access your Texas Children’s Health Plan managed insurance plan. You will be able to electronically access Health Plan features such as Coverage and Eligibility information, Referral Authorizations, Claims and Explanation of Benefits. You will also be able to access temporary ID cards, request replacement cards or submit a PCP change request.

Requests will be processed within one business day (if received before 5pm CT).

If you are an adult with existing Texas Children's MyChart account access seeking Member Portal access for yourself, you do not need to complete this form. You should already have access to member portal tools. If you do not see those tools, please call 1-877-361-0111 or 832-824-0140.

Member Information Verification

Are you a member?

YesNo

Please provide the member’s ID

Member's First Name

Member's Middle Name

Member's Last Name

Please enter the member's DOB

Please enter member’s legal sex

FemaleMale

Member's Street Address

Member's City

Member's State

Member's Zip Code

Legally Authorized Representative Verification

If you are not the member, please enter your:

First Name

Last Name

Street Address

City

State

Zip Code

What is your phone number on file with Texas Health and Human Services (HHS)?

Is your email address on file with Texas HHS?

YesNo

If so, please provide it

MyChart Account Confirmation

Do you currently have access to the member’s Texas Children's Hospital chart through MyChart? If so, please provide the following...

Do you have Texs Children's MyChart Access?

YesNo

MyChart User Name

Your name as it is listed in your account

The email address associated with your account

New Account Information

If you do not have an existing MyChart account already, please provide the following…

Please enter your DOB

Please provide your email address

Required. If your email is on file with Texas HHS, it must be the same address that is listed above.

Please provide your cell phone number

Optional. Used for text message activation and clinical notification purposes only, your carrier’s standard text message rates may apply

How would you prefer to receive your activation instructions?

Text/SMS

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