N.Y. Comp. Codes R. & Regs. tit. 11, § 55.2
(d) The insurer shall advise the policyholder that the policyholder's notice to the certificate holder shall be either:
(f) The insurer shall advise the policyholder that in accordance with the provisions of Labor Law, section 217(4), the provisions of this Part and Labor Law, section 217(3) shall not be deemed to apply if, at least 10 days prior to the date of the intended termination, as specified in the insurer's notice of intent to terminate, the policyholder has:
(2) contracted with another insurer to replace the existing insurer for the providing of similar coverage for the same certificate holders, and filed an affidavit with the Commissioner of Labor and Superintendent of Financial Services to that effect;
(i) affidavits filed with the Commissioner of Labor shall refer to Labor Law, section 217, and be addressed to:
Director of Labor Standards
Department of Labor
Agency Building 12
State Office Building Campus
Albany, NY 12240
(ii) affidavits filed with the Superintendent of Financial Services shall refer to Labor Law, section 217 and this Part, and shall be addressed to:
Chief, Health Bureau
New York State Department of Financial Services
One Commerce Plaza
Albany, NY 12257