Bosnia and Herzegovina

Clinical Trial Application	Bosnia Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Unknown
Standard Limits	650,000 USD Per Patient/ 4,000,000 USD Per Trial (if issued by a local insurer)
Tail Coverage	5 years
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in Bosnian • Site List in English and Bosnian, inclusive of Full Name(s) of Principal Investigator(s), the Hospital(s)/Site Location(s) Address(es) with Area Code No refund for policy cancellation

Clinical Trial Application	Belgium Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Yes
Standard Limits	Between 400.000 and 600.000 €/patient Between 3.000.000 and 5.000.000 €/protocol
Tail Coverage	3 years
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in French • Local EU Representative details (Contact Person Name, Address, Telephone Number and E-Mail Address). Not required if Sponsor is domiciled in the EU.