Insurers and regulated entities

New for 2020

There are no changes from the 2019 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."

New for 2019

There are no changes from the 2018 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."

New for 2021

There are no changes from 2020 for the surplus line broker tax forms.

Filing requirements

All business entities with a surplus line broker license and unaffiliated individuals with a surplus line broker license in the State of Washington during the tax year must complete a form, even if no business was actually transacted within Washington during the tax period. Please review surplus line broker reporting and tax requirements if you are not sure if you need to file.

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 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 tax rate is 2%. Calculations are completed automatically.

The Surplus Line Association of Washington (SLA) enters premiums on your behalf as a courtesy; your tax form will not be available to file until they have entered your premiums. The tax contact OIC has on file for your entity will receive an email notification when your premiums have been entered.

The surplus line broker tax form is read-only.

Important: It is your responsibility as a surplus line broker to ensure your premiums are entered correctly. If you don't agree with the premium amounts entered on the tax form, contact SLA of Washington.

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 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 2020

There are no changes from the 2019 surplus line tax forms.

Filing requirements

All business entities with a surplus line broker license and unaffiliated individuals with a surplus line broker license in the State of Washington during the tax year must complete a form, even if no business was actually transacted within Washington during the tax period. Please review surplus line broker reporting and tax requirements if you are not sure if you need to file.

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 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 tax rate is 2%. Calculations are completed automatically.

The Surplus Line Association of Washington (SLA) enters premiums on your behalf as a courtesy; your tax form will not be available to file until they have entered your premiums. The tax contact OIC has on file for your entity will receive an email notification when your premiums have been entered.

The surplus line broker tax form is read-only.

Important: It is your responsibility as a surplus line broker to ensure your premiums are entered correctly. If you don't agree with the premium amounts entered on the tax form, contact SLA of Washington.

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 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."

Filing requirements

All business entities with a surplus line broker license and unaffiliated individuals with a surplus line broker license in the State of Washington during the tax year must complete a form, even if no business was actually transacted within Washington during the tax period. Please review surplus line broker reporting and tax requirements if you are not sure if you need to file.

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 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 tax rate is 2%. Calculations are completed automatically.

The Surplus Line Association of Washington (SLA) enters premiums on your behalf as a courtesy; your tax form will not be available to file until they have entered your premiums. The tax contact OIC has on file for your entity will receive an email notification when your premiums have been entered.

The surplus line broker tax form is read-only.

Important: It is your responsibility as a surplus line broker to ensure your premiums are entered correctly. If you don't agree with the premium amounts entered on the tax form, contact SLA of Washington.

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 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 surplus line broker tax forms.

Filing requirements

All business entities with a surplus line broker license and unaffiliated individuals with a surplus line broker license in the State of Washington during the tax year must complete a form, even if no business was actually transacted within Washington during the tax period. Please review surplus line broker reporting and tax requirements if you are not sure if you need to file.

Due date

The completed online form and payment must be received by the 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 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 tax rate is 2%. Calculations are completed automatically.

The Surplus Line Association of Washington (SLA) enters premiums on your behalf as a courtesy; your tax form will not be available to file until they have entered your premiums. The tax contact OIC has on file for your entity will receive an email notification when your premiums have been entered.

The surplus line broker tax form is read-only.

 Important: It is your responsibility as a surplus line broker to ensure your premiums are entered correctly. If you don't agree with the premium amounts entered on the tax form, contact SLA of Washington.

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 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."

Annual report filing instructions

2024

• 2024 DPO annual report instructions (PDF 201.72KB)
• 2024 DPO annual report attestation (PDF 60.01KB)

2023

• 2023 DPO annual report instructions (PDF 395.38KB)
• 2023 DPO annual report attestation (PDF 107.10KB)

Refer to these resources for specific instructions on how to use the portal to file your annual report and the templates required to complete your financial filing:

• Conflict of interest statement (PDF 98.15KB)
• Accessing the portal (PDF 176.00KB)
• Portal menu options (PDF 430.60KB)
• Filling out page 1 of the annual report (PDF 313.71KB)
• Attaching documents to page 2 of the annual report (PDF 383.96KB)
• Filling out and submitting page 3 (PDF 622.17KB)

File your annual report for discount plan organizations