Annual Premium Tax And Fees Instructions (Page 2 of 2) in pdf

E-HMDO.xls

is for Hospital, Medical, Dental and Optometric (“HMDO”) Service Corporations only, to report exempt

government premiums. DO NOT file this schedule if you are not an HMDO. Do not file a “0” schedule.

PART 3 – EXEMPT

PREMIUMS: Must be reported

A deduction for FCIC Reinsured Crop/Hail requires an Affidavit signed by a company officer confirming the amount

claimed.

A deduction for Medicare premiums requires a copy of the letter issued by CMS granting approval to the company to

serve as a Medicare Advantage plan for a period that includes the calendar year the deduction is taken.

Any “Other” deductions from Gross Premiums require attachments to describe and support them.

PART 4 – GENERAL INSTRUCTIONS

YOUR ARIZONA CERTIFICATE OF AUTHORITY DICTATES YOUR COMPANY TYPE. If your company type is not listed

on Page 1 or if you need to confirm your company type, please call (602) 364-3999 and provide your NAIC Number.

Send ONE payment for Premium Tax, Retaliatory Tax AND/OR Annual Fees due.

Send separate checks for

Installment Tax payments.

PAYMENT OPTIONS

You can no longer pay fees by ACH credit. You can electronically pay fees using the NAIC OPTins system.

DEDUCTIONS FOR DIVIDENDS

You may deduct dividends paid in cash or left on deposit. Dividends applied to pay renewal premiums may be deducted

ONLY IF they are included in your Gross premiums reported.

ARIZONA GUARANTY FUND ASSESSMENT PREMIUM TAX OFFSETS - ARS §§ 20-674 and 20-692

There are no Arizona Guaranty Fund offsets available, as no assessments have been made in the past 5 years.

ENTERPRISE ZONE CREDIT OR MILITARY REUSE ZONE CREDIT

Call the Tax Unit at (602) 364-3997 if you need these forms. You must FIRST be certified by the Arizona Department of

Commerce to claim this credit.

HEALTH INSURANCE CREDIT CERTIFICATES ISSUED BY THE ARIZONA DEPARTMENT OF REVENUE

Report the TOTAL amount of Health Insurance Credit Certificates issued by the Arizona Department of Revenue that are

EFFECTIVE in this Calendar Year period. The full amount of credit stated in each Credit Certificate that is effective in this

Calendar Year period should be deducted in this Calendar Year period. Do not attempt to allocate Credit Certificates

among multiple calendar years.

RETALIATION - ARS § 20-230

All fees and taxes are retaliated in the aggregate pursuant to the retaliatory law of the Arizona Insurance Code.

ANNUAL PREMIUM TAX REFUNDS

This Department will refund premium tax overpayments resulting from Installment Taxes paid in excess of the Annual Tax

liability without interest and WITHIN 90 DAYS from the due date of your annual tax report. DO NOT OFFSET Annual Fees

or Retaliatory Taxes due for any portion of a premium tax overpayment.

DUE DATE

Annual tax reports and payments are due March 1st. If March 1 falls on a Saturday or Sunday, the deadline is extended

to the following Monday. To be considered a TIMELY filing, the package containing your filing or payment must display

validation by the United States Postal Service* as proof of the date of filing. Courier deliveries must include an invoice

bearing the date of courier pick-up. If your package does not provide evidence of a timely filing it will be considered filed

WHEN RECEIVED and penalties and interest may be assessed. *Postage meter stamps do not qualify.

IMPORTANT – DO NOT mail tax forms or payments inside Annual Statement packages. You must mail all tax forms and

payments to Attention: Tax Unit at the address shown on the form.

PENALTY AND INTEREST FOR LATE TAX PAYMENTS

We may assess a penalty fee of up to $25 per day if you pay fees late. ARS § 20-223(D).

We may assess a civil penalty and interest if you pay tax late. ARS § 20-225(A). Penalty is 5% of the tax amount paid

late but not less than $25 and interest is 1% per month. If penalty and interest are not included with a late tax payment,

we will send an assessment with a notice of your appeal rights.

We may summarily suspend your Certificate of Authority if you do not timely pay the renewal fee. ARS § 20-217(E).

E-ANNUALTAX.INSTRUCTION (Rev. 12/08)

Arizona Department of Insurance

Page 2 of 2

Annual Premium Tax And Fees Instructions Page 2

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