Tax Forms and Instructions for Insurers

As of October 31, 2014

INSTRUCTIONS

STEPDESCRIPTION

1

Open the attached Annual Taxes and Fees Data Sheet. Print only the Data Sheet page that contains information about the insurer/entity -- do not print the entire document. The Data Sheet page will provide instructions telling you what you need to submit. See instructions on the first page of the Annual Taxes and Fees Data Sheet document.

2

Make sure the information in the "INFORMATION ABOUT THE INSURER" section of insurer's Data Sheet appears to be correct. Contact the Insurance Tax Unit if you have questions. The Data Sheet provides information that is essential to properly filing taxes and fees.

3

Follow the directions that appear immediately above the "INFORMATION ABOUT THE INSURER" section on the insurer's Data Sheet.

If the entity is required to complete the Annual Tax and Fees Report (Form E-TAX), download and carefully read the companion instructions document (Form E-TAX-I).

4

Foreign and alien insurance entities must use information applicable to its domicile that is provided in the Arizona Retaliation Guide (updated 2/24/2014) to help determine the taxes, fees and assessments that the insurer's domicile would impose on an Arizona-domiciled insurer. Each foreign and alien entity should review the GENERAL INFORMATION provided on the first page of the Guide before reviewing information pertaining to the entity's domicile.

5

If submitting an amended tax report form (E-TAX, E-RT, E-TC), you must also complete and submit the E–TAX–AMEND spreadsheet.

6

Below are links to forms you may need to complete. Review the entire list of forms. Download, save to your computer, complete and submit all required forms.

FORMS

FORM DESCRIPTION

Tax and Fee Data Sheets

 

Contains important information for properly fulfilling annual reporting and payment requirements.

 

E-AHP Accountable Health Plan Small Employer Determination. Complete this report and
the E-SGHI workbook if all the following apply:
  • The entity is approved in Arizona as an accountable health plan; AND
  • The entity issued health benefits plans to small employers (see definitions of "health benefits plan"- ARS § 20-2301(A)(11) and "small employer" - ARS § 20-2301(A)(21); AND
  • The entity notified the small employers of the reduction to the premium tax because of the tax exemption (ARS § 20-2304(J)); AND
  • The entity complied with all other provisions of ARS §§ 20-2301 et seq.
E-FBS (Rev. 1/7/2014) Foreign Fraternal Benefit Society Annual Fees and Retaliation Report. Complete this form if the Data Sheet indicates it is required for the entity.
E-FV (Rev. 1/7/2014) Fire and Vehicle Premiums: Must be completed by each insurer or other risk-bearing entity that is required to complete Form E-TAX and that transacted any of the following lines of insurance coverage during the tax year: Fire, allied lines, farmowners, homeowners, commercial non-liability, inland marine, automobile/vehicle, or write-ins.

E-INSTALL (XLS, Rev. 3/18/2013)

 

Installment Tax Report: Each insurer that has a premium tax liability of $2,000 or more for the tax year must file installment payments during the current year by the 15th of each month, March through August.

To pay installments, either use the NAIC OPTins system OR complete and submit E–INSTALL with a check or money order that shows your NAIC number in the memo section.

  • Do not remit installment payments with any other types of payments.
  • An insurer may pay more than one installment in a single payment.
  • Failure to pay an installment when due may result in the imposition of a civil penalty equal to the greater of $25 or 5% of the amount due, plus interest at a rate of 1% per month from the due date. ARS § 20–225.
E-LRTF (XLS, Rev. 3/19/2012) Survey of Arizona Domestic Insurers: Local and Regional Tax and Fee Payments. Every Arizona-domiciled insurer, including risk retention groups, must complete this survey, which is due March 1. Submit as an OPTins attachment or on a CD-ROM labeled with the insurer's name, the insurer's NAIC number and "E-LRTF."
E-RT (Rev. 12/16/2013) Retaliation Report: Must be completed by every foreign or alien insurer or other risk-bearing entity that is required to complete Form E-TAX.

The entity must use information applicable to its domicile that is provided in the Arizona Retaliation Guide to help determine the taxes, fees and assessments that the insurer's domicile would impose on an Arizona-domiciled insurer. Each foreign and alien entity should review the GENERAL INFORMATION provided on the first page of the Guide before reviewing information pertaining to the entity's domicile.

E-SGHI (XLS, Rev. 1/27/2012)

 

Accountable Health Plan Small-employer Group Health Insurance. Complete this workbook and Form E-AHP and submit as OPTins file attachments or on a CD-ROM labeled with the insurer's name, NAIC number and "E-SGHI" if all the following apply:

  • The entity is approved in Arizona as an accountable health plan; AND
  • The entity issued health benefits plans to small employers (see definitions of "health benefits plan"- ARS § 20-2301(A)(11) and "small employer" - ARS § 20-2301(A)(21); AND
  • The entity notified the small employers of the reduction to the premium tax because of the tax exemption (ARS § 20-2304(J)); AND
  • The entity complied with all other provisions of ARS §§ 20-2301 et seq.
E-TAX (Rev. 1/7/2014) Annual Tax and Fees Report: Complete this form if the Data Sheet indicates it is required for the entity. Also review Form E-TAX instructions (see E-TAX-I).
E-TAX-AGENTS (XLS Rev. 1/13/2013) Insurance Producer Appointments: A foreign/alien insurer that is required to complete Form E-TAX must complete this workbook if the insurer's domicile imposes license or appointment fees upon Arizona-domiciled insurers (as indicated in the section of the Arizona Retaliation Guide that pertains to the insurer's domicile).
E-TAX-AMEND (XLSM Rev. 3/24/2014) E-TAX-AMEND: You must complete and submit this form with amended tax report forms E-TAX, E-RT, E-FV, and/or E-TC. This form calculates differences bewteen entries on your original report and entries on your amended report.
E-TAX-I (Rev. 1/7/2014) Annual Tax and Fees Report Instructions: Carefully review the information in this document to help you properly complete Form E-TAX. Contact the Insurance Tax Unit if you have questions.
E-TC (Rev. 1/7/2014) Tax Credits: Must be completed by each insurer or other risk-bearing entity that is claiming, applying or carrying forward premium tax credits or offsets.
E-TITLE (Rev. 1/7/2014) Foreign Title Insurer Retaliation Report:Complete this form if the Data Sheet indicates it is required for the entity.
E-UCLDR (Rev. 1/2011) Unafiiliated Credit Life and Disability Reinsurer Annual Fees Report: Complete this form if the Data Sheet indicates it is required for the entity.

E-ZONE
(Rev. 2/2014)

Enterprise Zone Credit Reporting. If the entity intends to claim an enterprise zone credit, the entity must

  • Save the E-ZONE.xlsx (Microsoft Excel) workbook to your computer or network.
  • Complete the E-ZONE.xlsx workbook.
  • Either submit the workbook as an electronic attachment to an OPTins tax filing, or on a CD-ROM submitted with a mailed tax report. If submitting on a CD-ROM, you must write the insurer's NAIC number, insurer name and "E-ZONE" on the CD-ROM.
  • Enter the enterprise zone credits claimed, applied and carried forward on Form E-TC.
  • You can only obtain third-year E-ZONE credit for a qualified employment position that meets all the following standards:
    • The employee must reside in Arizona.
    • The position must be at least 1,750 hours of full-time employment.
    • The insurer must pay for at least 50% of the employee's health insurance premium or membership cost.
    • The insurer must pay compensation at least equal to the wage offer by county as last computed by the Arizona Department of Economic Security.

ADDITIONS TO THE RATE OF TAX (AAC R20-6-205)
Information from the following documents is incorporated in the Arizona Retaliation Guide:

NEED HELP?

  • Send e-mail to Tax Unit Supervisor Susan Yepez: syepez@azinsurance.gov
  • Call the Insurance Tax Unit at (602) 364-3998

PROVIDE YOUR FEEDBACK


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