2018 Schedule 800a - Insurance Premiums License Tax Worksheet - Virginia

This "Schedule 800a - Insurance Premiums License Tax Worksheet" is a Virginia-specific form released by the Virginia Department of Taxation on May 1, 2018.

Download the form by clicking the link below, fill it out by hand, and mail it as per the guidelines provided by the department or the applicable legal instructions.

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Schedule 800A
2018 Virginia Insurance Premiums License Tax Worksheet
Transfer the amounts on Lines 11 and 12 in Columns C and D to Form 800, Lines 6 and 7.
Column A
Column B
Column C
Column D
Direct Premium
Net Additions/
Premiums Taxed at
Premiums Taxed at
Insurance Type
Income Reported on
Subtractions
2.25%
1.00%
Schedule T
1. Property, Casualty, and Title Insurers – All types of insurance . . . . . . . . . . . . . . . .
2. Life, Accident, and Sickness Insurers
a. Life, Disability, and Double Indemnity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Accident and Sickness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Industrial Sick Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Legal Service Plans – Gross amount of all Virginia subscriber income . . . . . . . . . .
4. Limited Health Service Organizations / Dental and Optometric Service Plans
a. Income Derived from Primary Small Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Income Derived from Large Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. All Other Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Health Service Plans
a. Income Derived from Primary Small Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Income Derived from Large Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. All Other Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Risk Retention Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Mutual Assessment Property and Casualty Insurers
If exempt, enter “0” for tax and enclose Schedule 844 . . . . . . . . . . . . . . . . . . . . . . . .
8. Cooperative Nonprofit Life Benefit Companies; Mutual Assessment Life,
Accident & Sickness Insurers; Burial Societies . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Dental Plan Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Joint Underwriting Associations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter direct premium
Enter taxable premium
Enter taxable premium
amount here and on
amount here and on
amount here and on
Form 800, Line 1.
Form 800, Line 6a.
Form 800, Line 7a.
11. Taxable Premium Amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Multiply Column C,
Multiply Column D,
Line 11 by 2.25%.
Line 11 by 1.00%.
Also enter on Form 800,
Also enter on Form 800,
Line 6b.
Line 7b.
12. Insurance Premiums License Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Va. Dept. of Taxation 6201173 Rev. 05/18
Schedule 800A
2018 Virginia Insurance Premiums License Tax Worksheet
Transfer the amounts on Lines 11 and 12 in Columns C and D to Form 800, Lines 6 and 7.
Column A
Column B
Column C
Column D
Direct Premium
Net Additions/
Premiums Taxed at
Premiums Taxed at
Insurance Type
Income Reported on
Subtractions
2.25%
1.00%
Schedule T
1. Property, Casualty, and Title Insurers – All types of insurance . . . . . . . . . . . . . . . .
2. Life, Accident, and Sickness Insurers
a. Life, Disability, and Double Indemnity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Accident and Sickness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Industrial Sick Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Legal Service Plans – Gross amount of all Virginia subscriber income . . . . . . . . . .
4. Limited Health Service Organizations / Dental and Optometric Service Plans
a. Income Derived from Primary Small Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Income Derived from Large Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. All Other Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Health Service Plans
a. Income Derived from Primary Small Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Income Derived from Large Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. All Other Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Risk Retention Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Mutual Assessment Property and Casualty Insurers
If exempt, enter “0” for tax and enclose Schedule 844 . . . . . . . . . . . . . . . . . . . . . . . .
8. Cooperative Nonprofit Life Benefit Companies; Mutual Assessment Life,
Accident & Sickness Insurers; Burial Societies . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Dental Plan Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Joint Underwriting Associations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter direct premium
Enter taxable premium
Enter taxable premium
amount here and on
amount here and on
amount here and on
Form 800, Line 1.
Form 800, Line 6a.
Form 800, Line 7a.
11. Taxable Premium Amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Multiply Column C,
Multiply Column D,
Line 11 by 2.25%.
Line 11 by 1.00%.
Also enter on Form 800,
Also enter on Form 800,
Line 6b.
Line 7b.
12. Insurance Premiums License Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Va. Dept. of Taxation 6201173 Rev. 05/18

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