N.Y. Comp. Codes R. & Regs. tit. 11, § 101.7 – Filing of evidence of provider stop loss insurance.

(a) the name of the stop loss insurer which issued the policy;
(b) the policy form number;
(c) the name of the insured;
(d) the effective dates of the policy;
(e) the applicable policy limits;
(f) the applicable retention amounts and participation limits, if any; and
(g) that the terms and conditions of the insurance policy conform with all of the requirements of this Part.

If a health care provider elects to purchase a provider stop loss insurance policy to satisfy, in part, the requirements of this Part, the stop-loss insurer shall provide the insurer and superintendent with evidence that appropriate coverage is in effect, in the form of a certificate of insurance which shall specify: