Fillable Form M11h - Insurance Premium Tax Return For Hmos

2017 Insurance Premium Tax Return for HMOs Instructions

For insurance tax laws, see Minnesota Statutes, Chapter 297I at

Before You File

Line Instructions

You must also pay electronically if you’re

required to pay any Minnesota business tax

Round amounts to the nearest dollar.

You Need a Minnesota Tax ID

electronically, such as sales or withholding

Decrease any amount less than 50 cents

Your Minnesota tax ID is the seven-digit

tax.

and increase any amount that is 50 cents or

number you are assigned when you register

more to the next higher dollar.

To pay electronically, go to the depart-

with the Department of Revenue. You must

include your Minnesota tax ID on your

ment’s website at

If the reported premiums are different from

return so that your filing and any payments

and log in to e-Services. If you don’t have

the premiums on the state page or Schedule

you make are properly credited to your

Internet access, call 1-800-570-3329 to

T, attach a schedule reconciling the differ

account.

pay by phone. You’ll need your user name,

ence.

password and bank routing and account

If you do not have a Minnesota tax ID, ap-

numbers. When paying electronically, you

Line 1

ply online at or

must use an account not associated with any

call 651-282-5225 or 1-800-657-3605.

Total Premiums

foreign banks.

Enter total gross written premiums from

It is also important to enter your federal ID

If you use other electronic payment

NAIC, Schedule T.

number and NAIC number on your return,

methods, such as ACH credit method or

but not in place of your Minnesota tax ID

Fed Wire, instructions are available on our

Line 2

number.

website or by calling Business Registration

None Taxable Premiums

Office at 651-282-5225 or 1-800-657-3605.

Filing Requirements

2a. Enter all premiums from Federal em-

Any health care provider organized as a

Submit separate payments for each return.

ployees health benefits.

nonprofit health plan corporation, health

2b. Enter all nontaxable Medicare premi-

Check Payments

maintenance organization, accountable

ums.

If you’re not required to pay electronically

provider networks (APN) or community

and are paying by check, visit our website

integrated service network that writes pre-

2c. Enter all other nontaxable premiums.

at and click on

miums in Minnesota must file Form M11H,

Attach a separate itemized schedule.

“Make a Payment” and then “By check” to

Insurance Premium Tax Return for HMOs.

create a voucher. Print and mail the voucher

(M.S. 297I.05)

Line 4

with a check made payable to Minnesota

Other Additions

Due Date

Revenue.

Enter other adjustments to the premiums

File Form M11H with all required attach-

When you pay by check, your check autho-

include risk adjustment payments, broker

ments and pay any tax due by March 1.

rizes us to make a one-time electronic fund

fees, finance and service charges. Attach a

Payment extensions are not allowed.

transfer from your account, and you may

separate itemized schedule.

not receive your cancelled check.

The U.S. postmark date, or date recorded or

Estimated Tax Payments

marked by a designated delivery service, is

Note: If no amount is due or if you pay

considered the filing date (private postage

If your estimated premium tax is more than

electronically, do not send in a voucher.

meter marks are not valid). When the due

$500, you must make estimated payments

date falls on a Saturday, Sunday or legal

Penalties and Interest

based on the entire estimated amount. To

holiday, returns and payments electroni-

avoid an additional charge for underpaying

Late Payment. If you do not pay all the tax

cally made or postmarked the next business

the tax, your payments must be made on

due by the due date, a late payment penalty

day are considered timely. When a return

time and be at least one-fourth of the prior

is due. The penalty is 5 percent of the

or payment is late, the date it is received at

year’s total annual tax liability, or one-

unpaid tax for any part of the first 30 days

the Department of Revenue is treated as the

fourth of 80 percent of the current year’s

the payment is late, and 5 percent for each

date filed or paid.

total annual tax liability.

additional 30-day period, up to a maximum

Extension for Filing Return. If good cause

of 15 percent.

Estimated payments are due quarterly on

exists, you may request a filing extension.

March 15, June 15, Sept. 15 and Dec. 15.

Late Filing. Add a late filing penalty to

When the due date falls on a weekend or

the late payment penalty if your return is

Check Boxes

legal holiday, payments made electronically

not filed by the due date. The penalty is

or postmarked on the next business day are

At the top of the form, check if the return

5 percent of the unpaid tax. When added

considered timely.

is:

to the late payment penalty, the maximum

combined penalty is 20 percent.

an Amended Return: Check only if you’re

Make a Payment

Payment Method. If you’re required to

amending a previously filed return for the

pay electronically and do not, an additional

same period. Include all original and cor-

Electronic Payments

5 percent penalty applies to payments not

rected premiums on the amended return.

If your total insurance taxes and surcharges

made electronically, even if a paper check

for the last 12-month period ending June

a No Activity Return: Check only if you

is sent on time.

30 is $10,000 or more, you’re required to

did not have any tax activity during the

pay your tax electronically in all subsequent

year. Note: If no amount is due or if you

Continued

years.

pay electronically, do not send in a voucher.

Form M11h - Insurance Premium Tax Return For Hmos - 2017 Page 2

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