Annual Premium Tax And Fees Instructions - State Of Arizona
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1
2Department of Insurance
State of Arizona
ANNUAL PREMIUM TAX AND FEES
Financial Affairs Division – Tax Unit
INSTRUCTIONS
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269
Telephone: (602) 364-3998
Facsimile: (602) 364-3989
PART 1 – Which form to file:
You must file ONE of the forms listed below, by the due date stated on the form.
Form E-ANNUALFEES
must be filed by the following types of companies:
MECHANICAL
QUALIFIED REINSURER TRUST /
ACCREDITED
LIFE & DISABILITY
TITLE
REIMBURSEMENT
QUALIFIED REINSURER BASED ON
REINSURER
REINSURER
INSURER
REINSURER
SURPLUS
even if no TAX is due
Form E-ANNUALTAX
must be filed by the following types of companies
:
FRATERNAL
PROPERTY &
MORTGAGE
PREPAID
LIFE & DISABILITY
RISK RETENTION
BENEFIT
CASUALTY
GUARANTY
LEGAL
INSURER
GROUP
SOCIETY
INSURER
INSURER
INSURER
even if no TAX is due
Form E-HEALTHORG
must be filed by the following types of companies
:
HOSPITAL, MEDICAL, DENTAL AND
HEALTH CARE SERVICES
PREPAID DENTAL PLAN
OPTOMETRIC SERVICE
ORGANIZATION
ORGANIZATION
CORPORATION
YOUR ARIZONA CERTIFICATE OF AUTHORITY DICTATES YOUR COMPANY TYPE. If your company type is not listed
above or if you need to confirm your company type, please call (602) 364-3999 and provide your NAIC Number.
PART 2 – ADDITIONAL FORMS:
Do not file “0” Schedules or Schedules that do not apply to your company.
Form E-AHP
is for approved Accountable Health Plans only, to report Small Group Premiums exempt from tax. DO
NOT file this form if you are not an approved Accountable Health Plan. Call the Life & Health Division at (602) 364-2393 if
you need to confirm your status as an approved Accountable Health Plan. Do not file a “0” Schedule.
Form E-HEALTHORG.HMDO
is for Hospital, Medical, Dental and Optometric (“HMDO”) Service Corporations only, to
report exempt government premiums. DO NOT file this form if you are not an HMDO. Do not file a “0” Schedule.
Form E-TITLE.RETALIATORY
must be filed by a Foreign Title insurer instead of Form SCH-RT.
Form
SCH-RT, our RETALIATORY SCHEDULE, must be filed by all FOREIGN and ALIEN companies that file Form E-
ANNUALTAX except TITLE Insurers, who must file Form E-TITLE.RETALIATORY (as stated above).
Form
SCH-AFP, for ARIZONA FIRE PREMIUMS, must be filed if you wrote FIRE, FARMOWNERS MULTI-PERIL,
HOMEOWNERS MULTI-PERIL OR COMMERCIAL MULTI-PERIL business in Arizona. Do not file a “0” Schedule.
Form
SCH-AVP, for ARIZONA VEHICLE PREMIUMS, must be filed if you wrote insurance coverage on or for vehicles in
Arizona. Do not file a “0” Schedule.
PART 3 – EXEMPT
PREMIUMS: Must be reported
See Part 2 above for exempt Accountable Health Plan Small Group premium and HMDO exempt government premium.
An FCIC Reinsured Crop/Hail deduction requires an Affidavit signed by a company officer confirming the amount claimed.
A deduction of Medicare Title XVIII 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.
An “Other” deduction from Gross Premiums requires an attachment to describe it and support the amount entered.
PART 4 – GENERAL INSTRUCTIONS
Send ONE payment for Premium Tax, Retaliatory Tax AND/OR Annual Fees due. Send separate checks or ACH
Deliveries for Annual Tax/Fees and Installment Tax payments.
PAYMENT OPTIONS
1.
-
.
ACH CREDIT DELIVERY
MUST BE MADE IN THE FORMAT AND CONTENT STATED IN FORM E
ACH
INSTRUCTION
2. CHECK PAYABLE TO
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E-ANNUALTAX.INSTRUCTION (Rev. 12/07)
ARIZONA DEPARTMENT OF INSURANCE
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