Form 25-205 - Computation Of Non-Taxable Insurance Premiums Page 2

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Form 25-205 (Back) (Rev.12-12/18)

Additional Information

Premiums and revenues received from the state treasury for insurance coverage on Medicaid and the Children’s Health Insurance Program (CHIP) are

subject to premium and maintenance taxes as of Sept. 1, 2003.

Insurers' contributions for employee benefit plans may be deducted if they have been included in the amount of gross premiums reported in Item 1 and/

Item 1

or Item 11 on Form 25-100. These contributions are not considered premium receipts of the insurance company.

Item 2(c) Premiums reported in Column C should be excluded from the tax base for calculation of maintenance taxes (Form 25-102). See instructions for

maintenance tax (Form 25-300) for Item 7.

Enrollees for whom revenues are reported in Column B should be excluded from the tax base for calculation of maintenance taxes (Form 25-102). See

instructions for maintenance tax (Form 25-300) for Items 13, 14 and 15.

Item 2(d) The premiums reported under this item must be supported by a separate itemized schedule indicating the names of the municipalities, counties or hospital

districts of Texas and the amount of premium received for each policy. A copy of the trust agreement must also be maintained to substantiate the exemption

claimed. Premiums from a municipality, county or hospital district employee group are exempted only if they are paid from a single nonprofit trust.

Item 3

Premiums reported in Columns A and C and revenues reported in Column B should be excluded from the tax base for calculation of maintenance taxes (Form

25-102). Premiums for community supervision and correction department employees, dependents and retired employees are exempt under Section 1551.114,

Texas Insurance Code, effective Sept. 1, 2004. See instructions for maintenance tax (Form 25-300) for Items 7, 8, 13, 14 and 15.

Item 4

The premiums reported under this item must be supported by a separate itemized schedule indicating the names of the colleges/universities and the

amount of premiums received from each.

Premiums reported in Columns A and C and revenues reported in Column B should be excluded from the tax base for calculation of maintenance taxes

(Form 25-102). See instructions for maintenance tax (Form 25-300) for Items 7, 8, 13, 14 and 15.

Item 5

The premiums reported under this item must be supported by a separate itemized schedule indicating the names of the insureds and the amount of

premiums received from each.

Premiums reported in Columns A and C and revenues reported in Column B should be excluded from the tax base for calculation of maintenance taxes

(Form 25-102). See instructions for maintenance tax (Form 25-300) for Items 7, 8, 13, 14 and 15.

Item 6

The premiums for optional coverage for permanent life insurance, long-term care insurance and short-term loss of salary because of disability are not taxable.

Item 7

The premiums reported under this item must be supported by maintaining a sample copy of the policy issued from which the premium was received.

Item 9

The issuer of a children's health plan approved under Chapter 1502, Texas Insurance Code, is exempt from premium and retaliatory taxes under Chapters

222 and 281, Texas Insurance Code. These policies are subject to maintenance taxes.

A health benefit plan issuer regulated under Chapter 1501, Texas Insurance Code, is exempt from the premium tax under Chapter 222, Texas Insurance

Item 13

Code, for a period of two years on the premiums or revenues received for coverage provided to previously uninsured employees or dependents who are

members of a health group cooperative (as defined by the Commissioner of Insurance). Refer to Texas Department of Insurance Rule, Subchapter D,

Health Group Cooperatives, 28 TAC, §26.405. This applies to health benefit plans that are delivered, issued for delivery, amended or renewed on or after

Jan. 1, 2004.

The additional information required must be maintained by the taxpayer and made available upon request by the Comptroller. Failure to provide the

information upon request will result in the disallowance of the exemption claimed.