Instructions For Annual Premium Tax And Fees Report Form November 2009 Page 2
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2ADDITIONAL SCHEDULES
(Only file if you have information to report. Do not file “0” schedules)
•
E-AHP.xls (for accountable health plans only): Complete only if you are approved as an accountable
health plan to report small group premiums that are exempt from tax. ARS § 20-2304. Do not file if you had
no exempt small group premiums. You can e-mail this file to us, please call for instructions.
•
E-AZ AGENTS.xls (for foreign and alien insurers only): Check with the insurance department in your
state of domicile (or, for an alien insurer, the port of entry state) to determine whether the state requires
Arizona insurers to pay appointment fees or termination fees for agents doing business in that state.
Complete only if your state of domicile requires Arizona companies to pay any of these fees. Complete only
the column(s) in the schedule that pertain to the type(s) of fees (appointment or termination) that Arizona
insurers must pay for their agents doing business in your state of domicile. You can e-mail this file to us,
please call for instructions.
•
E-HMDO.xls (for HMDO’s only): Complete only if you are a Hospital, Medical, Dental and Optometric
(“HMDO”) Service Corporation that received government premiums exempt from tax. ARS § 20-837. You
can e-mail this file to us, please call for instructions.
REQUIRED DOCUMENTATION FOR DEDUCTIONS AND CREDITS
Report all premiums (whether taxable or exempt) as gross premiums and show deductions from gross
premiums and credits in the applicable sections of your tax report form.
•
If claiming a deduction for FCIC-reinsured crop/hail premiums, include an affidavit signed by a company
officer confirming the amount claimed.
•
If claiming a deduction for Medicare premiums, include a copy of the letter or other documentation issued
by CMS granting your approval to serve as a Medicare Advantage Plan for a period that includes the
calendar year of the deduction.
•
You may deduct dividends paid in cash or left on deposit. Dividends applied to pay renewal premiums may
be deducted ONLY IF you included them in gross premiums.
•
Describe and justify any other deductions from gross premiums in an attachment.
•
To claim an Enterprise Zone Credit or Military Reuse Zone Credit, the Arizona Department of Commerce
st
must FIRST certify you as eligible by March 1
. Call the Tax Unit at (602) 364-3998 for credit forms.
•
Do not claim Arizona Guaranty Fund offsets. No assessments have been made in the past five years.
•
To claim a Health Insurance Credit, report the total amount of Health Insurance Credit Certificates you
received from the Arizona Department of Revenue that were effective during the calendar year and deduct
the full amount of credit stated in the Certificates. Do not allocate credits among multiple calendar years.
•
To claim School Tuition Organization (STO) Credits, complete the STO Credit Schedule.
FILING AND PAYMENT INSTRUCTIONS
We no longer accept ACH payments. You can electronically file tax reports and pay taxes and fees using
the NAIC OPTins system:
•
Visit the NAIC Web site at
•
View
the
Industry
Tutorial
or
download
the
Industry
User
Manual
found
on
•
Contact the OPTins Help Desk at
or (816) 783-7990
Note: To use OPTins, you must establish an account and electronic funds transfer protocol with the NAIC, which
can take up to two weeks.
Avoid penalties, interest charges or license suspension
by filing your tax report and
(ARS §§ 20-217, -223, -225)
payment on time. A filing is timely if ►we receive it by the due date, ►you transmit your filing electronically
using OPTins at least two business days prior to the due date or ►a package containing your filing shows
evidence that a courier picked it up by the due date ► your package is postmarked by the United States Postal
Service by the due date. Postage metering does not qualify.
Include ONE payment for the total premium tax, retaliatory tax and/or annual fees due. Send separate checks
for Installment Tax payments.
DO NOT MAIL TAX FORMS OR PAYMENTS INSIDE YOUR ANNUAL STATEMENT PACKAGE. Mail tax
th
forms and payments to Tax Unit, 2910 North 44
Street, Suite 210, Phoenix, AZ 85018-7269.
If we owe you a tax refund based on Installment Taxes paid, we will issue it by May 30th.
ARS § 20-224.02
E-ANNUALTAX.INSTRUCTION (Rev. 11/09)
Arizona Department of Insurance
Page 2 of 2
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