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:
(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.N.Y. Comp. Codes R. & Regs. Tit. 11 § 101.7