Nebraska Department of Insurance
NEBRASKA DOMESTIC PREMIUM TAX FORMS
Please choose your company's line of insurance from the following list. Each form is a seperate file and must be downloaded seperately. If you do not find your line of insurance, please contact Martha Hettenbaugh at 402-471-2201.
Property and Casualty Insurer
- This packet contains the following forms:
Health Maintenance Organization OR Life and Health Insurer
- This packet contains the following forms:
- State Filing Checklist and Instructions
- Annual Premium Tax Return Instructions
- Annual Premium Tax Return
- Quarterly Premium Tax Return
- Nebraska Small Employer Health Reinsurance Program (NSEHRP)
- Comprehensive Health Insurance Pool (CHIP)
- Request for Fraud Contact and Suspected Fraudulent Claim Report
Title Company
- This packet contains the following forms: