Insurers and regulated entities

New for 2020

There are no changes from 2019 for the reinsurer tax forms.

Filing requirements

All reinsurers 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 our office 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

The Washington 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.

Reinsurer Premiums and Fees

Premiums as Reported on the Annual Statement

Premiums entered in this section must match premiums reported for Washington on the State Page Exhibit filed with the National Association of Insurance Commissioners (NAIC).

Fee Details

If your company is no longer active in Washington and this is your final return, enter $0 in both columns as the Renewal Fee.

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

The fields in this section are populated from other areas of the tax form.

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."

New for 2019

There are no changes from 2018 for the reinsurer tax forms.

Filing requirements

All reinsurers 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 our office 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

The Washington 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.

Reinsurer Premiums and Fees

Premiums as Reported on the Annual Statement

Premiums entered in this section must match premiums reported for Washington on the State Page Exhibit filed with the National Association of Insurance Commissioners (NAIC).

Fee Details

If your company is no longer active in Washington and this is your final return, enter $0 in both columns as the Renewal Fee.

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

The fields in this section are populated from other areas of the tax form.

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."

New for 2023

There are no changes from the 2022 risk retention group tax forms.

Filing requirements

All risk retention groups registered 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 OIC 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 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 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.

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 as Reported on the Annual Statement

Premiums entered in this section should, with few exceptions, match premiums reported for Washington on the corresponding lines of the Exhibit of Premiums and Losses (state page) filed with the National Association of Insurance Commissioners (NAIC).

Excess Bail Bonds are bail bond premiums and fees in excess of those reported on the state page and are not included in Line 24 or 34; please report these premiums using the unnumbered line under Line 34.

Schedule guidance

Schedule A - Property/Casualty Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule A instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed Authorized Company	Report reinsurance assumed from authorized companies	n/a
Reinsurance Assumed Unauthorized Company	Report reinsurance assumed from unauthorized companies	n/a
Reinsurance Assumed Authorized Company	Report reinsurance assumed your state of domicile allows to be claimed	n/a
Dividends Paid to Policyholders	Report dividends your state of domicile allows to be claimed	n/a
Losses Paid to Policyholders	Report losses paid your state of domicile allows to be claimed	n/a
Other Deductions (specify)	Provide description and amount of deduction allowed, if any	n/a
Variable tax rate adjustment	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule B - Ocean Marine Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Losses Paid on Reinsurance

Schedule B instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed	Report reinsurance assumed your state of domicile allows to be claimed	Report reinsurance assumed
Reinsurance Ceded	Report reinsurance ceded your state of domicile allows to be claimed	Report reinsurance ceded
Direct Losses Paid (Deduct Salvage)	Report direct losses paid your state of domicile allows to be claimed	Report direct losses paid
Report losses paid on reinsurance your state of domicile allows to be claimed	Report losses paid on reinsurance
Recoveries on Reinsurance Ceded	Report recoveries on reinsurance ceded your state of domicile allows to be claimed	Report recoveries on reinsurance ceded
Ocean Marine Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule C - Fire Marshal and/or Fire Department Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule C instructions for risk retention groups

Line name	State of domicile	State of Washington
Fire Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	n/a

Schedule D - Other Taxes and Credits

Schedule D instructions for risk retention groups

Line name	State of domicile	State of Washington
Other Taxes Assessed (Specify) (two lines)	Provide a specific description and amount of taxes assessed, if any (see note below)	n/a
Other Credit Allowed (Specify) (two lines)	Provide a specific 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, MTA tax, or a minimum tax.

Summary

All fields in this section are populated from other areas of the the tax form.

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 tax purposes; please make sure the information is accurate.

Enter the name and title of the officer who 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."

New for 2022

Risk retention group tax forms were updated to match the NAIC's annual statement format.

The following lines were added to the tax form:

• 11.1 Medical Professional Liability - Occurrence
• 11.2 Medical Professional Liability - Claims-Made
• 13.1 Comprehensive (hospital and medical) ind
• 13.2 Comprehensive (hospital and medical) group (b)
• 15.9 Other Health (b)
• 18.1 Products Liability - Occurrence
• 18.2 Products Liability - Claims Made

Additionally, name changes were made to lines 15.1 - 15.7.

Filing requirements

All risk retention groups registered 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 OIC 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 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 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.

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 as Reported on the Annual Statement

Premiums entered in this section should, with few exceptions, match premiums reported for Washington on the corresponding lines of the Exhibit of Premiums and Losses (state page) filed with the National Association of Insurance Commissioners (NAIC).

Excess Bail Bonds are bail bond premiums and fees in excess of those reported on the state page and are not included in Line 24 or 34; please report these premiums using the unnumbered line under Line 34.

Schedule guidance

Schedule A - Property/Casualty Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule A instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed Authorized Company	Report reinsurance assumed from authorized companies	n/a
Reinsurance Assumed Unauthorized Company	Report reinsurance assumed from unauthorized companies	n/a
Reinsurance Assumed Authorized Company	Report reinsurance assumed your state of domicile allows to be claimed	n/a
Dividends Paid to Policyholders	Report dividends your state of domicile allows to be claimed	n/a
Losses Paid to Policyholders	Report losses paid your state of domicile allows to be claimed	n/a
Other Deductions (specify)	Provide description and amount of deduction allowed, if any	n/a
Variable tax rate adjustment	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule B - Ocean Marine Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Losses Paid on Reinsurance

Schedule B instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed	Report reinsurance assumed your state of domicile allows to be claimed	Report reinsurance assumed
Reinsurance Ceded	Report reinsurance ceded your state of domicile allows to be claimed	Report reinsurance ceded
Direct Losses Paid (Deduct Salvage)	Report direct losses paid your state of domicile allows to be claimed	Report direct losses paid
Report losses paid on reinsurance your state of domicile allows to be claimed	Report losses paid on reinsurance
Recoveries on Reinsurance Ceded	Report recoveries on reinsurance ceded your state of domicile allows to be claimed	Report recoveries on reinsurance ceded
Ocean Marine Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule C - Fire Marshal and/or Fire Department Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule C instructions for risk retention groups

Line name	State of domicile	State of Washington
Fire Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	n/a

Schedule D - Other Taxes and Credits

Schedule D instructions for risk retention groups

Line name	State of domicile	State of Washington
Other Taxes Assessed (Specify) (two lines)	Provide a specific description and amount of taxes assessed, if any (see note below)	n/a
Other Credit Allowed (Specify) (two lines)	Provide a specific 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, MTA tax, or a minimum tax.

Summary

All fields in this section are populated from other areas of the the tax form.

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 tax purposes; please make sure the information is accurate.

Enter the name and title of the officer who 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."

New for 2021

There are no changes from 2020 for the risk retention group tax forms.

Filing requirements

All risk retention groups registered 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 OIC 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 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 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.

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 as Reported on the Annual Statement

Premiums entered in this section should, with few exceptions, match premiums reported for Washington on the corresponding lines of the Exhibit of Premiums and Losses (state page) filed with the National Association of Insurance Commissioners (NAIC).

Excess Bail Bonds are bail bond premiums and fees in excess of those reported on the state page and are not included in Line 24 or 34; please report these premiums using the unnumbered line under Line 34.

Schedule guidance

Schedule A - Property/Casualty Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule A instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed Authorized Company	Report reinsurance assumed from authorized companies	n/a
Reinsurance Assumed Unauthorized Company	Report reinsurance assumed from unauthorized companies	n/a
Reinsurance Assumed Authorized Company	Report reinsurance assumed your state of domicile allows to be claimed	n/a
Dividends Paid to Policyholders	Report dividends your state of domicile allows to be claimed	n/a
Losses Paid to Policyholders	Report losses paid your state of domicile allows to be claimed	n/a
Other Deductions (specify)	Provide description and amount of deduction allowed, if any	n/a
Variable tax rate adjustment	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule B - Ocean Marine Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Losses Paid on Reinsurance

Schedule B instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed	Report reinsurance assumed your state of domicile allows to be claimed	Report reinsurance assumed
Reinsurance Ceded	Report reinsurance ceded your state of domicile allows to be claimed	Report reinsurance ceded
Direct Losses Paid (Deduct Salvage)	Report direct losses paid your state of domicile allows to be claimed	Report direct losses paid
Report losses paid on reinsurance your state of domicile allows to be claimed	Report losses paid on reinsurance
Recoveries on Reinsurance Ceded	Report recoveries on reinsurance ceded your state of domicile allows to be claimed	Report recoveries on reinsurance ceded
Ocean Marine Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule C - Fire Marshal and/or Fire Department Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule C instructions for risk retention groups

Line name	State of domicile	State of Washington
Fire Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	n/a

Schedule D - Other Taxes and Credits

Schedule D instructions for risk retention groups

Line name	State of domicile	State of Washington
Other Taxes Assessed (Specify) (two lines)	Provide a specific description and amount of taxes assessed, if any (see note below)	n/a
Other Credit Allowed (Specify) (two lines)	Provide a specific 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, MTA tax, or a minimum tax.

Summary

All fields in this section are populated from other areas of the the tax form.

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 tax purposes; please make sure the information is accurate.

Enter the name and title of the officer who 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."

New for 2020

There are no changes from 2019 for the risk retention group tax forms.

Filing requirements

All risk retention groups registered 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 OIC 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 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 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.

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 as Reported on the Annual Statement

Premiums entered in this section should, with few exceptions, match premiums reported for Washington on the corresponding lines of the Exhibit of Premiums and Losses (state page) filed with the National Association of Insurance Commissioners (NAIC).

Excess Bail Bonds are bail bond premiums and fees in excess of those reported on the state page and are not included in Line 24 or 34; please report these premiums using the unnumbered line under Line 34.

Schedule guidance

Schedule A - Property/Casualty Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule A instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed Authorized Company	Report reinsurance assumed from authorized companies	n/a
Reinsurance Assumed Unauthorized Company	Report reinsurance assumed from unauthorized companies	n/a
Reinsurance Assumed Authorized Company	Report reinsurance assumed your state of domicile allows to be claimed	n/a
Dividends Paid to Policyholders	Report dividends your state of domicile allows to be claimed	n/a
Losses Paid to Policyholders	Report losses paid your state of domicile allows to be claimed	n/a
Other Deductions (specify)	Provide description and amount of deduction allowed, if any	n/a
Variable tax rate adjustment	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule B - Ocean Marine Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Losses Paid on Reinsurance

Schedule B instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed	Report reinsurance assumed your state of domicile allows to be claimed	Report reinsurance assumed
Reinsurance Ceded	Report reinsurance ceded your state of domicile allows to be claimed	Report reinsurance ceded
Direct Losses Paid (Deduct Salvage)	Report direct losses paid your state of domicile allows to be claimed	Report direct losses paid
Report losses paid on reinsurance your state of domicile allows to be claimed	Report losses paid on reinsurance
Recoveries on Reinsurance Ceded	Report recoveries on reinsurance ceded your state of domicile allows to be claimed	Report recoveries on reinsurance ceded
Ocean Marine Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule C - Fire Marshal and/or Fire Department Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule C instructions for risk retention groups

Line name	State of domicile	State of Washington
Fire Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	n/a

Schedule D - Other Taxes and Credits

Schedule D instructions for risk retention groups

Line name	State of domicile	State of Washington
Other Taxes Assessed (Specify) (two lines)	Provide a specific description and amount of taxes assessed, if any (see note below)	n/a
Other Credit Allowed (Specify) (two lines)	Provide a specific 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, MTA tax, or a minimum tax.

Summary

All fields in this section are populated from other areas of the the tax form.

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 tax purposes; please make sure the information is accurate.

Enter the name and title of the officer who 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."

New for 2019

The Premium Reporting section on the tax form has been updated to align with the changes to the Exhibit of Premiums and Losses (state page) and now includes Line 29 International.

Tax forms have been updated to calculate tax due, even in states with variable rates. If you are filing for a company that is domiciled in a state with variable or multiple tax rates, please review the schedule-specific instructions below.

The Office of Insurance Commissioner (OIC) now provides a resource to aid foreign companies in retaliatory reporting. The list is not all-inclusive, but does provide common fees, assessments, and surcharges that must be reported.

• List of fees, assessments and surcharges subject to retaliation (PDF 637.78KB)

Filing requirements

All risk retention groups registered 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 OIC 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 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 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.

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 as Reported on the Annual Statement

Premiums entered in this section should, with few exceptions, match premiums reported for Washington on the corresponding lines of the Exhibit of Premiums and Losses (state page) filed with the National Association of Insurance Commissioners (NAIC).

Excess Bail Bonds are bail bond premiums and fees in excess of those reported on the state page and are not included in Line 24 or 34; please report these premiums using the unnumbered line under Line 34.

Schedule guidance

Schedule A - Property/Casualty Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule A instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed Authorized Company	Report reinsurance assumed from authorized companies	n/a
Reinsurance Assumed Unauthorized Company	Report reinsurance assumed from unauthorized companies	n/a
Reinsurance Assumed Authorized Company	Report reinsurance assumed your state of domicile allows to be claimed	n/a
Dividends Paid to Policyholders	Report dividends your state of domicile allows to be claimed	n/a
Losses Paid to Policyholders	Report losses paid your state of domicile allows to be claimed	n/a
Other Deductions (specify)	Provide description and amount of deduction allowed, if any	n/a
Variable tax rate adjustment	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule B - Ocean Marine Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Losses Paid on Reinsurance

Schedule B instructions for risk retention groups

Line name	State of domicile	State of Washington
Reinsurance Assumed	Report reinsurance assumed your state of domicile allows to be claimed	Report reinsurance assumed
Reinsurance Ceded	Report reinsurance ceded your state of domicile allows to be claimed	Report reinsurance ceded
Direct Losses Paid (Deduct Salvage)	Report direct losses paid your state of domicile allows to be claimed	Report direct losses paid
Report losses paid on reinsurance your state of domicile allows to be claimed	Report losses paid on reinsurance
Recoveries on Reinsurance Ceded	Report recoveries on reinsurance ceded your state of domicile allows to be claimed	Report recoveries on reinsurance ceded
Ocean Marine Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	Pre-populated by the OIC

Schedule C - Fire Marshal and/or Fire Department Taxes

Some fields on this schedule are populated from the Premium Reporting section of the tax form.

Editable fields are indicated by a border around the field. Refer to the table below for entry details.

Schedule C instructions for risk retention groups

Line name	State of domicile	State of Washington
Fire Tax Rate	If editable, enter an adjustment that results in the correct tax calculation on the final line of the schedule	n/a

Schedule D - Other Taxes and Credits

Schedule D instructions for risk retention groups

Line name	State of domicile	State of Washington
Other Taxes Assessed (Specify) (two lines)	Provide a specific description and amount of taxes assessed, if any (see note below)	n/a
Other Credit Allowed (Specify) (two lines)	Provide a specific 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, MTA tax, or a minimum tax.

Summary

All fields in this section are populated from other areas of the the tax form.

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 tax purposes; please make sure the information is accurate.

Enter the name and title of the officer who 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."

New for 2023

Health company tax forms were updated to add two new lines under "Health Premiums - Other"

• Provider Access Payments (Received from HCA)
• Outpatient Directed Payments (Received from HCA)

Filing requirements

All health maintenance organizations, health care service contractors, and self-funded multiple employer welfare arrangements 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. The filing of any form other than the online one provided by this office is 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 tax rate is 2%. Calculations 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.

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

Health Premiums Written as Reported on the Annual Statement

All premiums and prepayments collected or received must be reported in this section.

Premiums reported in this section should, with few exceptions, match premiums reported for Washington on the Exhibit of Premiums, Enrollment and Utilization filed with the National Association of Insurance Commissioners (NAIC).

Health Premiums - Other

Medicaid pass-through payments are received from Washington State Health Care Authority and must be reported in this section.

ACA Risk Adjustments/Risk Corridor Transactions are payments paid or received. These transactions are not considered premiums for tax filing purposes.

• If your company paid Washington-related risk adjustment or risk corridor transactions, enter the amount as a positive number. This will reverse the amount reported on your annual statement that resulted in a premium reduction.
• If your company received Washington-related risk adjustment or risk corridor transactions, enter the amount as a negative number. This will reverse the amount reported on your annual statement that resulted in a premium increase.

Other (Specify) is to report premiums other than those reported on the lines above.

Health Premiums - Additional Detail

Premiums reported in this section are not in addition to premiums reported in the previous section; rather, they are a subset of those premiums.

Premiums reported in this section capture detail not available on the Exhibit of Premiums, Enrollment and Utilization. These premiums are carried through to the appropriate schedules as appropriate.

Non-Exchange Premiums

• General Assistance - Unemployable (GAU) premiums are payments received for services provided under RCW 74.09.035. Premiums entered are used to reduce the taxable premiums on Schedule A.
• Basic Health Plan (BHP) (Subsidized premiums) are premiums received on behalf of subsidized enrollees as provided in RCW 70.47. Premiums entered are used to reduce the taxable premiums on Schedule A.
• Adult Dental premiums entered are used to reduce the taxable premiums on Schedule A.
• Qualified Pediatric Dental Kids Only 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 A.
• Non-Qualified Pediatric Dental premiums entered are used to reduce the taxable premiums on Schedule A.

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 B.
• Adult Dental premiums reflect plans offered through the WA Exchange and reduces the taxable premium on Schedule B. 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 B.
• Qualified Stand-Alone Family Dental - Individual Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule B.
• Qualified Stand-Alone Family Dental - Small Group Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule B.
• Qualified Stand-Alone Family Dental - Large Group Market premiums entered are used to reduce the taxable premiums on Schedule B.

Schedule guidance

Schedule A - Non-Exchange Health Taxes

Most fields on this schedule are populated from the Premium Reporting section of the tax form.

If your company received Title XVIII Medicare premiums, stand-alone Medicare Part D payments, or other premiums federally exempt from taxation, report the tax exempt portion of the premiums on this schedule.

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 B. If there are no premiums reported on Schedule B, the excess credit is carried forward to the next tax year.

Schedule B - Exchange Health Taxes

All fields on this schedule are populated from the Premium Reporting section of the tax form.

The Health Pool Assessment Available, after being applied in Schedule A, 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.

Summary

Most fields of this section are populated from other areas of the tax form.

2019 premium tax overpayments, if any, will be applied to prepayments due for 2020. Overpayments in excess of 2020 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 who 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."

New for 2022

Health company tax forms were updated to match the NAIC's annual statement format.

The following lines were added to the tax form:

• Credit A&H
• Disability Income
• Long-Term Care
• Other Health
• Other Non-Health

Additionally, the Dental Only line has moved up one line and displays before Vision Only.

Filing requirements

All health maintenance organizations, health care service contractors, and self-funded multiple employer welfare arrangements 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. The filing of any form other than the online one provided by this office is 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 tax rate is 2%. Calculations 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.

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

Health Premiums Written as Reported on the Annual Statement

All premiums and prepayments collected or received must be reported in this section.

Premiums reported in this section should, with few exceptions, match premiums reported for Washington on the Exhibit of Premiums, Enrollment and Utilization filed with the National Association of Insurance Commissioners (NAIC).

Health Premiums - Other

Medicaid pass-through payments are received from Washington State Health Care Authority and must be reported in this section.

ACA Risk Adjustments/Risk Corridor Transactions are payments paid or received. These transactions are not considered premiums for tax filing purposes.

• If your company paid Washington-related risk adjustment or risk corridor transactions, enter the amount as a positive number. This will reverse the amount reported on your annual statement that resulted in a premium reduction.
• If your company received Washington-related risk adjustment or risk corridor transactions, enter the amount as a negative number. This will reverse the amount reported on your annual statement that resulted in a premium increase.

Other (Specify) is to report premiums other than those reported on the lines above.

Health Premiums - Additional Detail

Premiums reported in this section are not in addition to premiums reported in the previous section; rather, they are a subset of those premiums.

Premiums reported in this section capture detail not available on the Exhibit of Premiums, Enrollment and Utilization. These premiums are carried through to the appropriate schedules as appropriate.

Non-Exchange Premiums

• General Assistance - Unemployable (GAU) premiums are payments received for services provided under RCW 74.09.035. Premiums entered are used to reduce the taxable premiums on Schedule A.
• Basic Health Plan (BHP) (Subsidized premiums) are premiums received on behalf of subsidized enrollees as provided in RCW 70.47. Premiums entered are used to reduce the taxable premiums on Schedule A.
• Adult Dental premiums entered are used to reduce the taxable premiums on Schedule A.
• Qualified Pediatric Dental Kids Only 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 A.
• Non-Qualified Pediatric Dental premiums entered are used to reduce the taxable premiums on Schedule A.

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 B.
• Adult Dental premiums reflect plans offered through the WA Exchange and reduces the taxable premium on Schedule B. 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 B.
• Qualified Stand-Alone Family Dental - Individual Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule B.
• Qualified Stand-Alone Family Dental - Small Group Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule B.
• Qualified Stand-Alone Family Dental - Large Group Market premiums entered are used to reduce the taxable premiums on Schedule B.

Schedule guidance

Schedule A - Non-Exchange Health Taxes

Most fields on this schedule are populated from the Premium Reporting section of the tax form.

If your company received Title XVIII Medicare premiums, stand-alone Medicare Part D payments, or other premiums federally exempt from taxation, report the tax exempt portion of the premiums on this schedule.

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 B. If there are no premiums reported on Schedule B, the excess credit is carried forward to the next tax year.

Schedule B - Exchange Health Taxes

All fields on this schedule are populated from the Premium Reporting section of the tax form.

The Health Pool Assessment Available, after being applied in Schedule A, 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.

Summary

Most fields of this section are populated from other areas of the tax form.

2019 premium tax overpayments, if any, will be applied to prepayments due for 2020. Overpayments in excess of 2020 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 who 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."

New for 2021

There are no changes from the 2020 health forms.

Filing requirements

All health maintenance organizations, health care service contractors, and self-funded multiple employer welfare arrangements 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. The filing of any form other than the online one provided by this office is 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 tax rate is 2%. Calculations 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.

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

Health Premiums Written as Reported on the Annual Statement

All premiums and prepayments collected or received must be reported in this section.

Premiums reported in this section should, with few exceptions, match premiums reported for Washington on the Exhibit of Premiums, Enrollment and Utilization filed with the National Association of Insurance Commissioners (NAIC).

Health Premiums - Other

Medicaid pass-through payments are received from Washington State Health Care Authority and must be reported in this section.

ACA Risk Adjustments/Risk Corridor Transactions are payments paid or received. These transactions are not considered premiums for tax filing purposes.

• If your company paid Washington-related risk adjustment or risk corridor transactions, enter the amount as a positive number. This will reverse the amount reported on your annual statement that resulted in a premium reduction.
• If your company received Washington-related risk adjustment or risk corridor transactions, enter the amount as a negative number. This will reverse the amount reported on your annual statement that resulted in a premium increase.

Other (Specify) is to report premiums other than those reported on the lines above.

Health Premiums - Additional Detail

Premiums reported in this section are not in addition to premiums reported in the previous section; rather, they are a subset of those premiums.

Premiums reported in this section capture detail not available on the Exhibit of Premiums, Enrollment and Utilization. These premiums are carried through to the appropriate schedules as appropriate.

Non-Exchange Premiums

• General Assistance - Unemployable (GAU) premiums are payments received for services provided under RCW 74.09.035. Premiums entered are used to reduce the taxable premiums on Schedule A.
• Basic Health Plan (BHP) (Subsidized premiums) are premiums received on behalf of subsidized enrollees as provided in RCW 70.47. Premiums entered are used to reduce the taxable premiums on Schedule A.
• Adult Dental premiums entered are used to reduce the taxable premiums on Schedule A.
• Qualified Pediatric Dental Kids Only 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 A.
• Non-Qualified Pediatric Dental premiums entered are used to reduce the taxable premiums on Schedule A.

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 B.
• Adult Dental premiums reflect plans offered through the WA Exchange and reduces the taxable premium on Schedule B. 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 B.
• Qualified Stand-Alone Family Dental - Individual Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule B.
• Qualified Stand-Alone Family Dental - Small Group Market premiums reflect plans offered through the WA Exchange and are taxed on Schedule B.
• Qualified Stand-Alone Family Dental - Large Group Market premiums entered are used to reduce the taxable premiums on Schedule B.

Schedule guidance

Schedule A - Non-Exchange Health Taxes

Most fields on this schedule are populated from the Premium Reporting section of the tax form.

If your company received Title XVIII Medicare premiums, stand-alone Medicare Part D payments, or other premiums federally exempt from taxation, report the tax exempt portion of the premiums on this schedule.

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 B. If there are no premiums reported on Schedule B, the excess credit is carried forward to the next tax year.

Schedule B - Exchange Health Taxes

All fields on this schedule are populated from the Premium Reporting section of the tax form.

The Health Pool Assessment Available, after being applied in Schedule A, 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.

Summary

Most fields of this section are populated from other areas of the tax form.

2019 premium tax overpayments, if any, will be applied to prepayments due for 2020. Overpayments in excess of 2020 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 who 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."