Health Insurance Study DB Project
Health Insurance Study DB Project
Health Insurance Study DB Project
Version: 1.7
01/06/2006
PROJECT INDEX
INTRODUCTION
Why Health insurance?
Your health is a wealth; if you invest in it you will live a happy life. But the health insurance
maybe sometimes expensive and confusing, therefore Rose Insurance Company helps you to
achieve peace of mind, security and to confront the financial difficulties in times of need.
How?
Through the use of free system. Where the insured for example can get medical assistance
without paying any bills, and Rose Insurance Company pays the bills directly to the health
care provider.
1. Insurance Programs:
Insurance companies provide many insurance programs, falling into two main types:
- Inpatient Insurance
- Outpatient Insurance
a. Inpatient Program:
There are many categories of Inpatient insurance provided by Jordanian insurance companies
in general. This gives the subscriber the flexibility and enables him to choose insurance that
meets his needs:
- First Class (VIP): special wings
- class A : First class residency (separate room)
- class B : joint residency (double beds or triple bed for three persons)
- class C : patients ward
There are also different levels of insurance coverage:
- 100%
- 90%
- 80%
b. Outpatient Program:
- Like the Inpatient insurance program ,the outpatient insurance is flexible enough to meet
all needs:
- 100% coverage
- 80% coverage
- Fees for:
o Doctors
o Physiotherapy
o Chemical treatment
o Radiotherapy
o Medicines
o Tests (including X ray, ECG, Lab and MRI)
2. Insurance Policy
Main information for Insurance Policy: Number, name, Insurance class, benefits and
coverage level of each program must be stated.
3. Business Procedures
The following is the procedure of subscribing with the Rose Insurance Company to get their
service as described by the company itself. The analysts decompose the main procedure to
tasks that can be measured as follows:
A-Group Insurance:
- Filling the application was the insurance client is the firm wishing to insure its
employees, and the party which bears the installments.
1
REF#01, Taken and modified AMusallami.
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Advanced Data Base Health Insurance Project - Group#01
- Filling the names of employees and theirs dependents/families (wishing to be insured)
dates of birth and relationship, stating the social status of the employee, also include
information about subscriber like: weight, height, national number if available and
nationality, getting his personal photos and a sample of his signature.
B-Individual insurance:
- Application is filled were the insurance of applicant (client) is the father or his agent, who
is committed to pay the installments.
- Filling names of family members, date of birth and relationship, mentioning the social
status of the insured (client), the profession of all persons insured, if applicable, including
also: weight, height, nationality and the national number if available.
- Determination of insurance Program required (inpatient or outpatient, inpatient and
outpatient) were each program specifies the coverage ratio according to the benefits
chosen (Doctors, Charges, medicines, residency and tests, keeping in mind to state class
(level of insurance) when choosing the inpatient or outpatient status.
- For both individuals and a groups insurance, a record must be made to include:
- Number of the insured, name, postal address, telephone numbers.
The insured person must be given a serial number according to the Program of insurance.
Each subscriber must belong to an insurance policy, also each subscriber is identified by his
insurance ID, also should have a subscription start & end date.
DEFINITION OF ENTITIES
1. Insurance Client (Group / Individual)
2. Subscriber
3. Insurance Policy
4. HCP – Health Care Provider
5. HCP Service Type
6. Insurance Program
7. Insurance Visits (Claims)
DEFINITION OF TABLES
Clients:
Subscribers (INSURED):
Medical History:
Insurance Policy:
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Advanced Data Base Health Insurance Project - Group#01
Services:
HCP_Services:
Insurance Program:
Insurance Claims:
Classes:
Coverage:
ERD
Policy_Name Policy_No Program_Name Program_No Program_Type
Number_Of_Insured
program
Start_Date POLICY
M Class_Name Class_Number
End_Date M M
HAS
1
COVERS HAS Class
COVERAGE M
1
Client_No Client_Type
P.O.Box
CLIENT
Client_Name Client_Address
1 Telephone
HCP
ID_No Photo
M
National_No
Signature
INCLUDED
M
Nationality
Social_Status OFFERS Service
F_Name
M
Date_Of_Birth
Name
N_Name
L_Name
Weight
End_Date
Professional Relation_Of_HOF
SUBSCRIBER CLIENT
Medical_History
Installment
1
1
Date Description
DEPENDED ON
HAS
MAKE
HOF_ID
M
M
VISIT CLAIM
MAPPING
Policy Policy_NO Client_NO(FK) Program_NO (FK) Policy_name Number_of_insured Start_date
(PK) (CLIENTS) (INSURANCE_PROGRAM)
NORMALIZATION
Since we followed the ER approach in designing our DB, the resulting design is already a
normalized one. According to First, Second and Third normal form.
SQL
This part of the project contains the needed DDL script needed to create the DB.
COMMIT;
DOCUMENT REFERENCES
- Ref#01: Rose Health Insurance Project, Arab Academy for Banking and Financial
Sciences, 20/01/2006 by Ahmad Al-Musallami, Hanan Mohsen, Murad Sabri, Amal
Alawneh, Alaa Darawsheh.
Document History
- Ver 1.0, 27/04/2006, AMusallami – Project Mini World & document basic structure.
- Ver 1.1, 30/04/2006, AMusallami – Enhancement of Mini World.
- Ver 1.2, 01/05/2006, AL-Namrouti – Some of Entities definition.
- Ver 1.3, 08/05/2006, Murad Sabri – All Tables definition.
- Ver 1.4, 20/05/2006, Update of design and ER based on Team Meeting.
- Ver 1.5, 28/05/2006, Moh Abu-Khadejeh – SQL DDL & Mapping.
- Ver 1.6, 31/05/2006, Alaa Darawsheh – Normalization.
- Ver 1.7, 01/06/2006, Amusallami – Document Compilation and standardization.