New for 2017
There are no changes from 2016 for the domestic life and disability tax forms.
Filing requirements
All life and disability insurance companies licensed in the State of Washington during the calendar year must file an online tax form, as provided by this office, even if no business was actually transacted within Washington during that time. Alternate filing methods are not accepted.
Due date
The completed online form and payment must be received by the Office of Insurance Commissioner on or before March 1 following the end of the calendar year. When the due date falls on a Saturday or Sunday, the form and payment are considered timely if received on the next business day.
Caution: Do not mail a paper version of the form or any attachments to our office.
Completing your premium tax form
Tax is generally due on all premiums, unless specifically exempted on the tax form. If you have questions, please contact us.
Premiums reported must be on the same basis as required on the Annual Statement.
The Washington state tax rate is 2%. Calculations for the Washington portion of the form will be completed automatically.
Selecting "Print" will print your form exactly as it appears on the screen, even if you have not saved your work.
Clicking the "Save Progress" button does not check for errors.
Remember: Save your work before moving away from the form; your work is not automatically saved.
Premium Reporting section
Premiums and Annuities as Reported on the Annual Statement
Life and annuity premiums entered in this section should, with few exceptions, match premiums reported for Washington on the corresponding lines of the Life Insurance (state) page filed with the National Association of Insurance Commissioners (NAIC).
Accident and health premiums entered in this section should, with few exceptions, match premiums reported for Washington on the corresponding lines of the Accident and Health Insurance (state) page filed with the NAIC.
Premiums and Annuities- Additional Detail
Premiums reported in this section are not in addition to premiums reported in the previous section; they are a subset of those premiums.
The purpose of breaking out the premiums is to allow us to accurately apply taxes and tax exemptions to the proper premiums. Premiums reported in this section capture detail not available on the Life Insurance and Accident and Health Insurance (state) pages of the Annual Statement. These premiums are carried through to the appropriate schedules.
Non-Exchange Premiums
Qualified Life premiums are certain products issued that are exempt or qualified under certain sections of the internal revenue code.
Qualified Life Dividends are from certain products issued that are exempt or qualified under certain sections of the internal revenue code.
Qualified Annuity premiums are certain products issued that are exempt or qualified under certain sections of the internal revenue code.
Qualified Annuity Dividends are from certain products issued that are exempt or qualified under certain sections of the internal revenue code.
Adult Dental premiums entered are used to reduce the taxable premiums on Schedule C.
Qualified Pediatric Dental Kids Only (Non-Exchange) premiums are for informational purposes only.
Qualified Stand-Alone Family Dental - Individual Market premiums are for informational purposes only.
Qualified Stand-Alone Family Dental - Small Group Market premiums are for informational purposes only.
Qualified Stand-Alone Family Dental - Large Group Market premiums entered are used to reduce the taxable premiums on Schedule C.
Non-Qualified Pediatric Dental premiums entered are used to reduce the taxable premiums on Schedule C.
Exchange Premiums
Tax revenue from all WA Exchange premiums is required to be deposited into an account separate from other tax revenue at the state treasury.
Qualified Health Plan premiums reflect plans offered through the WA Exchange and are taxed on Schedule D.
Adult Dental premiums reflect plans offered through the WA Exchange and reduces the taxable premium on Schedule D. In 2016, no stand-alone adult dental plans were offered through the Exchange.
Qualified Pediatric Dental Kids Only premiums reflect plans offered through the WA Exchange and are taxed on Schedule D.
Qualified Stand-Alone Family Dental - Individual Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule D.
Qualified Stand-Alone Family Dental - Small Group Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule D.
Qualified Stand-Alone Family Dental - Large Group Market premiums entered are used to reduce the taxable premiums on Schedule D.
Schedule A - Life Premium Taxes
Some fields on this schedule are populated from the Premium Reporting section of the tax form.
Editable fields are indicated on the tax form by a border around the field. Refer to the table below for entry details for these fields.
| Line name | State of domicile | State of Washington |
|---|---|---|
| Army and Air Force Exchange Service (AAFES) Group Life Premiums | Enter AAFES Group Life premiums received | Enter AAFES Group Life premiums received |
| Qualified Life Premiums | Report qualified life premiums your state of domicile allows to be claimed | Populated from Premium Reporting section |
| Other Deductions (specify) (two rows) | Provide description and amount of deduction allowed, if any | n/a |
| Life Tax Rate | If editable, enter your state of domicile life tax rate | Pre-populated by the Office of the Insurance Commissioner |
| Life Premium Taxes | If editable, enter taxes due to your state of domicile | Auto-calculated |
Schedule B - Annuity Taxes
Some fields on this schedule are populated from the Premium Reporting section of the tax form.
Editable fields are indicated on the tax form by a border around the field. Refer to the table below for entry details for these fields.
| Line name | State of domicile | State of Washington |
|---|---|---|
| Qualified Annuities | Report qualified annuity premiums your state of domicile allows to be claimed | Populated from Premium Reporting section |
| Other Deductions (specify) | Provide description and amount of deduction allowed, if any | n/a |
| Annuity Tax Rate | If editable, enter your state of domicile annuity tax rate | Pre-populated by the Office of the Insurance Commissioner |
| Annuity Taxes | If editable, enter taxes due to your state of domicile | Auto-calculated |
Schedule C - Non-Exchange Accident and Health Taxes
Some fields on this schedule are populated from the Premium Reporting section of the tax form.
Editable fields are indicated on the tax form by a border around the field. Refer to the table below for entry details for these fields.
| Line name | State of domicile | State of Washington |
|---|---|---|
| AAFES Group Accidental Death and Dismemberment Premiums | Enter AAFES Group Accidental Death and Dismemberment premiums received | Enter AAFES Group Accidental Death and Dismemberment premiums received |
| Other Deductions (specify) (two rows) | Provide description and amount of deduction allowed, if any | n/a |
| Adult Dental (Non-Exchange) | Report Adult Dental premiums your state of domicile allows to be claimed | Populated from Premium Reporting section |
| Qualified Stand-Alone Family Dental - Large Group Market (Non-Exchange) | Report Qualified Stand-Alone Family Dental - Large Group Market premiums your state of domicile allows to be claimed | Populated from Premium Reporting section |
| Non-Qualified Pediatric Dental (Non-Exchange) | Report Non-Qualified Pediatric Dental premiums your state of domicile allows to be claimed | Populated from Premium Reporting section |
| Health Pool Assessment | Enter Health Pool Assessment your state of domicile allows to be claimed | Pre-populated by the Office of the Insurance Commissioner (see note below) |
| Accident and Health Tax Rate | If editable, enter your state of domicile accident and health tax rate | Pre-populated by the Office of the Insurance Commissioner |
| Non-Exchange Accident and Health Taxes | If editable, enter taxes due to your state of domicile | Auto-calculated |
Note: The Health Pool Assessment Available is displayed on this schedule. If the credit available would reduce taxable premiums below zero, the excess credit is carried to Schedule D. If there are no premiums reported on Schedule D, the excess credit is carried forward to the next tax year.
Schedule D - Exchange Accident and Health Taxes
Some fields on this schedule are populated from the Premium Reporting section of the tax form.
Editable fields are indicated on the tax form by a border around the field. Refer to the table below for entry details for these fields.
| Line Name | State of Domicile | State of Washington |
|---|---|---|
| Adult Dental | Report Adult Dental Exchange premiums your state of domicile allows to be claimed | Populated from Premium Reporting section |
| Qualified Stand-Alone Family Dental - Large Group Market | Report Qualified Stand-Alone Family Dental - Large Group Market Exchange premiums your state of domicile allows to be claimed | Populated from Premium Reporting section |
| Other Deductions (specify) (two rows) | Provide description and amount of deduction allowed, if any | n/a |
| Health Pool Assessment | Enter Health Pool Assessment your state of domicile allows to be claimed | Pre-populated by the Office of the Insurance Commissioner (see note below) |
| Accident and Health Tax Rate | If editable, enter your state of domicile accident and health tax rate | Pre-populated by the Office of the Insurance Commissioner |
| Non-Exchange Accident and Health Taxes | If editable, enter taxes due to your state of domicile | Auto-calculated |
Note: The Health Pool Assessment Available, after being applied in Schedule C, is displayed on this schedule. If the credit available would reduce taxable premiums below zero, the excess credit is carried forward to the next tax year.
Schedule E - Other Taxes and Credits
| Line name | State of domicile | State of Washington |
|---|---|---|
| Other Taxes Assessed (Specify) (two rows) | Provide description and amount of taxes assessed, if any (see note below) | n/a |
| Other Credit Allowed (Specify) (two rows) | Provide description and amount of credit allowed, if any | n/a |
Note: Examples of taxes to report here may include, but are not limited to, franchise tax or a minimum tax.
Schedule F - Life and Disability Assessment Credits
The assessment credit is pre-populated by the Office of Insurance Commissioner and cannot be edited. The assessment credit is prorated at 20% per year for five years, unless the credit balance falls under $1,000.
Example: Your company pays an assessment of $2,000 in calendar year 2014.
Year 1 (2014): Credit of $400 used, balance of $1,600.
Year 2 (2015): Credit of $400 used, balance of $1,200.
Year 3 (2016): Credit of $400 used, balance of $800.
Year 4 (2017): Credit of $800 used, balance of $0.
| Tax year | State of domicile | State of Washington |
|---|---|---|
| 2017 - 2013 | Enter L&D Assessment your state domicile allows to be claimed | Pre-populated by the Office of the Insurance Commissioner |
| Other | Enter L&D assessment credit prior to 2013 your state of domicile allows to be claimed | n/a |
Schedule G - Filing and Miscellaneous Fees
If your company is no longer active in Washington and this is your final return, enter $0 in both columns for the Certificate of Authority Renewal Fee.
| Line name | State of domicile | State of Washington |
|---|---|---|
| Certificate of Authority Renewal Fee | Enter the Certificate of Authority renewal fee your state of domicile charges foreign insurers | Pre-populated by the Office of the Insurance Commissioner |
| Annual Statement Filing Fee | Enter the annual statement filing fee your state of domicile charges foreign insurers | Pre-populated by the Office of the Insurance Commissioner |
| Fraud Fee | If editable, enter the fraud fee from your state of domicile | n/a |
| Operating Fee | If editable, enter the operating fee/assessment your state of domicile would charge a foreign insurer | n/a; the Regulatory Surcharge cannot be claimed on the premium tax return |
| Other Misc Fees (specify) (two lines) | Provide description and amount of other fees charged by your state of domicile (see note below) | n/a |
Note: Examples of Other Misc Fees to report on this schedule may include, but are not limited to, cost containment fees, exam fees, or annual service fees.
Summary
All fields in this section are populated from other areas of the tax form.
2017 premium tax overpayments, if any, will be applied to prepayments due for 2018. Overpayments in excess of 2018 prepayments due will be processed as refunds and sent to the attention of the tax contact we have on file.
Declaration and final submission
Review the declaration and, if necessary, update the contact information.
The contact information listed here is the insurance commissioner's only point of contact for premium taxes and regulatory surcharge purposes; please make sure the information is accurate.
Enter the name and title of the officer that has examined the form and declares that to the best of this officer’s knowledge and belief, the information is entirely true, accurate and complete.
Submit your form to the insurance commissioner by clicking "Final Submission."