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This is how a real agency handles things.
At the Rookis Agency, we understand how confusing it can
be to handle the forms providers often require. So if your company uses Rookis,
you're covered. Simply click on the form you need below - be it a claim or
a change in your beneficiary - to download a PDF. Then call us for personal
guidance in completing the form and return it to the Rookis Agency. You can
drop it by the office, send by mail or fax to (205) 595-2241. We're here to make
this process easier for you. We want to review your claim form with you to help
verify it is complete. We'll even mail or fax your form from our office if you
like.
Forms in English
 Accident 
This PDF should be used to submit an accident claim. If you are also filing for disability benefits, please complete the Disability claim form.
Cancer
This PDF should be used to submit a claim for Cancer benefits, if you have a Cancer Policy.
Disability
This PDF should be used to submit a disability claim.
Continuing Disability
This PDF should be used to submit additional information for your on-going disability claim.
Health/Wellness Claim (less than a year old)
Submit online filing of health or wellness screening claims that are less than a year old.
Health/Wellness Claim
This PDF should be used for the express filing of health or wellness screening claims that are over a year old.
Pregnancy Claim
This PDF should be used for the express filing of pregnancy claims once you deliver. If you are filing for complications prior to delivery, please complete the Universal Claim Form.
Doctor's Office Visit (Medical Bridge 3000) - Less Than a Year
Submit online filing of doctor's office visit claims for Medical Bridge 3000 that are less than a year old.
Doctor's Office Visit (Medical Bridge 3000)
This PDF should only be used to submit a claim form for a doctor's office visit if you have a Medical Bridge 3000 policy.
Critical Illness
This PDF should be used to submit a claim for the critical illness benefit.
Group Supplemental Indemnity
This PDF should be used to submit a claim for the Indemnity benefit under Group Supplemental Hospital Policy.
Group Supplemental Hospital Confinement/Indemnity
This PDF should be used to submit a claim under the Group Supplemental Hospital policy offered by your employer, if available where you work.
Catastrophic Accident
This PDF should be used to submit a claim for the catastrophic accident benefit.
Universal Claim Form
This PDF can be used to submit a claim for disability, cancer, accident, and hospital confinement.
HIPAA Authorization
This PDF should be completed and returned with each claim form submitted.
Change of Beneficiary Form
This PDF form should be used to add or modify the designated beneficiary on a policy.
Request for Change of Ownership
This PDF form should be used to update owner and/or contingent owner information on a policy.
Request For Service
Use this PDF form to request changes to personal data, request a Beneficiary Change Form, or to exercise policy provisions.
Request For Service — Life
This PDF form should be used to request a loan, withdrawal, or cancellation/surrender of your life policy.
Loss of Life (Death) Notification Form
Submit Loss of Life Notification online.
Service Guide for Policyholders
This helpful flier provides information on finding the most up-to-date claim forms, submitting a claim and selecting optional services on the claim form. The form also provides helpful tips about the claims process, how the policy works and when to contact the service center.
Formularios en Espanol
Formulario para cambio de Designación de Beneficiario
Este formulario se usa para cambiar la designación de su beneficiario primario.
Formulario para la Presentación de una Reclamación
Este formulario se puede usar para procesar su reclamación.
Formulario para Solicitar Servicio
Use este formulario para cambiar su dirección u otra información personal, cambiar su beneficiario o para efectuar otros cambios relacionados con su póliza.
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