Arkansas Insurance Department

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Accounting Division

Phone:  (501) 371-2605

Fax:  (501) 682-6679

Email:  insurance.accounting@arkansas.gov


PREMIUM TAX FORMS/INFO FOR

FEDERALLY FACILITATED MARKETPLACE (FFM)

& PRIVATE OPTION HEALTH INSURERS ONLY

 

 

Ř   2016 QUARTERLY PREMIUM TAX FILINGS:
BEGINNING WITH THE 1ST QUARTER PREMIUM TAX FILING THAT IS DUE BY MAY 15, 2016, THE ARKANSAS INSURANCE DEPARTMENT WILL ONLY ACCEPT QUARTERLY TAX FILINGS & PAYMENTS THROUGH THE NAIC OPTins PREMIUM TAX PORTAL.  YOU SHOULD HAVE ALREADY RECEIVED (OR SHOULD SOON) OFFICAL NOTICE OF THIS CHANGE FROM THE NAIC AND OUR LEGAL DIVISION. FOR AN ADDITIONAL COPY OF THE NOTICE FROM AR INSURANCE COMMISSIONER ALLEN KERR, PLEASE CLICK HERE.  PER COMMISSIONER KERR, IT IS MANDATORY  THAT ALL 2016 QUARTERLY PREMIUM TAX FILINGS & PAYMENTS BE SUBMITTED THROUGH OPTins. ALL FUTURE TAX FILINGS & PAYMENTS WILL BE THROUGH OPTins. WE WILL NO LONGER HAVE THE QUARTERLY TAX FORMS AVAILABLE ON OUR WEBSITE OR EFT SITE.

 

 

·         CLICK THE APPROPRIATE LINK BELOW, COMPLETE THE FORM ONLINE, PRINT OFF,
SIGN, & SEND WITH YOUR CHECK. ONLY MARKETPLACE INSURERS ARE TO FILE
ON THESE FORMS.

·         PLEASE SIGN FORM IN BLUE INK.  ALL BLANKS ON THE FORM MUST BE COMPLETED. 

·         FORM MUST BE FILED EVEN IF “NONE”. IF YOU HAVE “NONE” FILINGS, PLEASE USE
THIS FORM AND MAIL TO US. 

·         IF YOU NEED A COPY OF OUR W-9, YOU CAN PRINT ONE FROM OUR ACCOUNTING
DIVISION WEBPAGE.

 

 

  ANNUAL FORMS & PAYMENTS ARE DUE BY MARCH 1ST EACH YEAR

 

  

   Send form & payment to:       Arkansas Insurance Department

                                                     Accounting Division

                                                     1200 West Third Street

                                                     Little Rock AR  72201-1904

 

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2015 ANNUAL PREMIUM TAX FORMS

PAYMENT MUST BE BY CHECK ONLY!

 

 FORM AID AC FFM-T  

 FOREIGN FEDERALLY FACILITATED MARKETPLACE (FFM) INSURERS
 PREMIUM TAX

 

 FORM AID AC PRIVATE OPTION-T  

 FOREIGN PRIVATE OPTION INSURER PREMIUM TAX

 

 FORM AID AC FFM-LD-T(D)

 DOMESTIC FEDERALLY FACILITATED MARKETPLACE (FFM) INSURERS
 PREMIUM TAX

 

 FORM AID AC PRIVATE OPTION-LD-T(D)

 DOMESTIC PRIVATE OPTION INSURER PREMIUM TAX

 

 FORM AID AC FFM HM-T  

 FEDERALLY FACILITATED MARKETPLACE (FFM) HOSPITAL MEDICAL
 SERVICE CORPORATIONS PREMIUM TAX

 

 FORM AID AC PRIVATE OPTION HM-T

 PRIVATE OPTION HOSPITAL MEDICAL SERVICE CORPORATIONS
 PREMIUM TAX

 

  MUST BE WET SIGNATURES IN BLUE INK.

 

2016 OPTins