Health Insurance Study DB Project

Arab Academy for Banking and Financial Sciences
Advanced Data Base

Dr.Jehad Al-Saadi
Health Insurance Project
Version: 1.7
01/06/2006
Prepared by Group#01 Team:

- Ahmad Al-Musallami
- Alaa Darawsheh
- Murad Sabri
- Raed Al-Namrouti
- Mohammad Abu-Khadegeh
Advanced Data Base Health Insurance Project - Group#01
PROJECT INDEX
• PROJECT INDEX ........................................................................................................................ 2

• INTRODUCTION ........................................................................................................................ 2
• MINI WORLD DESCRIPTION() ................................................................................................. 2
1. Insurance Programs:.............................................................................................................. 2
2. Insurance Policy.................................................................................................................... 2
3. Business Procedures.............................................................................................................. 2
• DEFINITION OF ENTITIES ....................................................................................................... 2
• DEFINITION OF TABLES.......................................................................................................... 2
• ERD............................................................................................................................................... 2
• MAPPING..................................................................................................................................... 2
• NORMALIZATION ..................................................................................................................... 2
• SQL ............................................................................................................................................... 2
• DOCUMENT REFERENCES...................................................................................................... 2
• TEAM CONTACTS (GROUP#01).............................................................................................. 2
• Document History......................................................................................................................... 2
ADB Project v1.7.doc 2/19 01/06/2006-03:30 PM

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.

MINI WORLD DESCRIPTION(1)
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:
First – Insurance Application:

- Determination of insurance client type stating wither it’s a Group insurance (a company
and its employees) or an individual's insurance.
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.
- 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.
- Determination of the insurance type (program) required (inpatient or outpatient, both

inpatient and outpatient), were each program specifies the coverage ratio according to the
benefits (services) chosen (Doctors charges, medicines, residency and tests) keeping in
mind to state the class (level of insurance) when choosing the inpatient or inpatient and
outpatient status.
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.
Second – Insurance Policy:

The application is considered by the issuance department which fixes the installments
according to the sex, age & Medical History.
The total installment value refers to (the grand total of all persons insured)
A file must be kept for each insurance policy, containing:

Policy Number, Number of persons insured, and the Insurance programs for each person
insured, the beginning of insurance date and the date of expiry.
Third – Insurance Subscriber:

Health insurance at the end is about people getting Healthcare services, regardless of their
insurance Type (Group/Individual). Those people are referred to as "Insurance Subscribers".
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.
Subscriber record should show the relation to the Policy:

a. HOF - Head Of Family: means that this subscriber is the direct person to benefit from
insurance, and might have other people subscribed through his subscription, ex. The
employee himself.
b. Dependent: is a subscriber who is a relative of a HOF subscriber, ex.the employee's
wife and children.
Forth – Visit Claims:

Health Insurance Company needs to keep a record of the Visit Claims received from HCPs
(Health Care Providers like Hospitals, Doctors, LABs, X-Ray centers). So for each claim it

needs to know: Subscriber ID, Visit date, Claim date, Claim HCP, Services & Amounts of
money charged for the visit.

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:
ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

CLIENT _NO NUMBER PK (‫رﻗﻢ اﻟﻌﻤﻴﻞ)اﻟﺰﺑﻮن‬
CLIENT_TYPE NUMBER UNIQUE KEY ) ‫ﻧﻮع اﻟﻌﻤﻴﻞ‬1:groups
2:individual (
CLIENT _NAME CHARACTER NON ‫اﺳﻢ اﻟﻌﻤﻴﻞ‬
P_O_BOX CHARACTER NON ‫ﺻﻨﺪوق اﻟﺒﺮیﺪ‬
ADDRESS CHARACTER NON ‫اﻟﻌﻨﻮان‬
TEL_NO NUMBER NON ‫رﻗﻢ اﻟﻬﺎﺗﻒ‬
Subscribers (INSURED):

SUBSCRIBER_ID NUMBER PK ‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﻲ ﻟﻼﺷﺨﺎص‬
CLIENT _NO NUMBER FK ‫رﻗﻢ اﻟﻌﻤﻴﻞ‬
NATIONAL_NO NUMBER UNIQUE KEY ‫اﻟﺮﻗﻢ اﻟﻮﻃﻨﻲ‬
F_NAME CHARACTER NON ‫اﻻﺳﻢ اﻻول‬
M_NAME CHARACTER NON ‫اﻻﺳﻢ اﻟﺜﺎﻧﻲ‬
L_NAME CHARACTER NON ‫اﻻﺳﻢ اﻻﺥﻴﺮ‬
DATE_OF_BIRTH DATE NON ‫ﺗﺎریﺦ اﻟﻤﻴﻼد‬
GENDER NUMBER NON ‫اﻟﺠﻨﺲ‬
SOCIAL_STATUS NUMBER NON ‫اﻟﺤﺎﻟﺔ اﻻﺝﺘﻤﺎﻋﻴﺔ‬
)‫ ﻡﺘﺰوج‬-١married(
)‫أﻋﺰب‬-٢single(
......... -٣
NATIONALITY NUMBAR NON ‫اﻟﺠﻨﺴﻴﺔ‬
PROFESSION NUMBER NON ‫اﻟﻤﻬﻨﺔ‬
HIGHT NUMBER NON ‫اﻟﻄﻮل‬
WIGHT NUMBER NON ‫اﻟﻮزن‬
PHOTO IMAGE NON ‫اﻟﺼﻮرة اﻟﺸﺨﺼﻴﺔ‬
SIGNITURE IMAGE NON ‫اﻟﺘﻮﻗﻴﻊ‬
INSTALLMENT NUMBER NON ‫اﻻﻗﺴﺎط‬
START_DATE DATE NOT NULL ‫ﺗﺎریﺦ ﺑﺪایﺔ اﻟﺘﺄﻡﻴﻦ‬
END_DATE DATE NOT NULL ‫ﺗﺎریﺦ ﻧﻬﺎیﺔ اﻟﺘﺄﻡﻴﻦ‬
RELATION_TO_HOF NUMBER NOT NULL ،‫ﺻﻠﺔ اﻟﺸﺨﺺ ﺑﺎﻟﻤﺆﻡﻦ اﻟﻤﺒﺎﺷﺮ)ﻧﻔﺴﻪ‬
‫ واﻟﺪ او‬،‫ اﺑﻦ اﺑﻨﺔ‬،‫زوج او زوﺝﺔ‬
(......‫واﻟﺪة‬
HOF_NO NUMBER NOT NULL ‫رﻗﻢ اﻟﻤﻌﻴﻞ‬
Medical History:

SUBSCRIBER_ID NUMBER PK ‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﻲ ﻟﻼﺷﺨﺎص‬
SERIAL NUMBER PK ‫ﺗﺴﻠﺴﻞ اﻟﺤﺎﻟﺔ اﻟﻤﺮﺿﻴﺔ‬
DATE DATE NOT NULL ‫ﺗﺎریﺦ اﻟﺤﺎﻟﺔ‬
DESCRIPTION CHARACTER NON ‫وﺻﻒ اﻟﺤﺎﻟﺔ‬
Insurance Policy:

POLICY_NO NUMBER PK ‫رﻗﻢ اﻟﻌﻘﺪ‬
POLICY_NAME CHARACTER NON ‫اﺳﻢ ﻡﺨﺘﺼﺮ ﻟﻠﻌﻘﺪ‬
CLIENT_NO NUMBER FK )‫رﻗﻢ اﻟﻌﻤﻴﻞ‬from clients table(
PROGRAM_NO NUMBER FK -‫ﻧﻮع اﻟﺒﺮﻧﺎﻡﺞ )داﺥﻞ اﻟﻤﺴﺘﺸﻔﻰ‬
‫ داﺥﻞ و ﺥﺎرج‬،‫ﺥﺎرج اﻟﻤﺴﺘﺸﻔﻰ‬
(‫اﻟﻤﺴﺘﺸﻔﻰ‬
START_DATE DATE NON ‫ﺗﺎریﺦ ﺑﺪایﺔ اﻟﺘﺄﻡﻴﻦ‬
END_DATE DATE NON ‫ﺗﺎریﺦ ﻧﻬﺎیﺔ اﻟﺘﺄﻡﻴﻦ‬
NUMBER_OF_INSURED NUMBER NON ‫ﻋﺪد اﻻﺷﺨﺎص اﻟﻤﺸﻤﻮﻟﻴﻦ ﺑﺎﻟﻌﻘﺪ‬
Health Care Provider(HPC):

HPC_NO NUMBER PK :‫رﻗﻢ ﻡﺰود اﻟﺨﺪﻡﺔ‬
HPC_NAME CHARACTER NON ‫اﺳﻢ ﻡﺰود اﻟﺨﺪﻡﺔ‬
Services:

SERVICE_NO NUMBER PK ‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﻲ ﻟﻠﺨﺪﻡﺔ‬
SERVICE_NAME CHARACTER NON ‫اﺳﻢ اﻟﺨﺪﻡﺔ‬
HCP_Services:

SERVICE_NO NUMBER PK ‫رﻗﻢ اﻟﺨﺪﻡﺔ‬
HCP_NO NUMBER PK :‫ﻧﻮع اﻟﺨﺪﻡﺔ‬
1-Doctors
2-Physiotherapy
3-Chemical
4-treatment
5-Radiotherapy
6-Medicines
Insurance Program:

PROGRAM_NO NUMBER PK ‫رﻗﻢ اﻟﺒﺮﻧﺎﻡﺞ‬
PROGRAM_TYPE NUMBER NOT NULL :‫اﻟﻨﻮع‬
‫ داﺥﻞ اﻟﻤﺴﺘﺸﻔﻰ‬-١
‫ ﺥﺎرج اﻟﻤﺴﺘﺸﻔﻰ‬-٢
‫ داﺥﻞ و ﺥﺎرج اﻟﻤﺴﺘﺸﻔﻰ‬-٣
PROGRAM_NAME CHARACTER NON ‫اﺳﻢ اﻟﺒﺮﻧﺎﻡﺞ‬

Insurance Claims:

CLAIM_NO NUMBER PK ‫رﻗﻢ اﻟﻤﻄﺎﻟﺒﺔ‬
SUBSCRIBER_NO NUMBER FK ‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﻲ ﻟﻠﺸﺨﺺ‬
)table from subscriber(
HCP_NO NUMBER FK ‫ﻧﻮع اﻟﺨﺪﻡﺔ‬
(from HCP table)
TREATMENT_DATE DATE NON ‫ﺗﺎریﺦ اﻟﻤﻌﺎﻟﺠﺔ‬
CLAIM_DATE DATE NON ‫ﺗﺎریﺦ ﺗﺴﺠﻴﻞ اﻟﻤﻄﺎﻟﺒﺔ‬
CLAIM_AMOUNT NUMBER NON ‫ﻗﻴﻤﺔ اﻟﻤﻄﺎﻟﺒﺔ‬
VISIT_DATE DATE NON ‫ﺗﺎریﺦ اﻟﺰیﺎرة‬
Classes:

CLASS_NO NUMBER PK ‫رﻗﻢ اﻟﺪرﺝﺔ‬
(1:VIP 2:A 3:B 4:C)
CLASS_NAME CHARACTER NON ‫اﺳﻢ اﻟﺪرﺝﺔ‬
Coverage:

PROGRAM_NO NUMBER PK ‫رﻗﻢ اﻟﺒﺮﻧﺎﻡﺞ‬
CLASS_NO NUMBER PK ‫رﻗﻢ اﻟﺪرﺝﺔ‬
SERVICE_NO NUMBER PK ‫رﻗﻢ اﻟﺨﺪﻡﺔ‬
COVERAGE_PCT NUMBER NON ‫ﻧﺴﺒﺔ اﻟﺘﻐﻄﻴﺔ‬
)number between 0 to 100(

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
Address HCP_No HCP_Name
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
Hieght Service_No Service_Name

Start_Date
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
Claim_No Claim_Date Visit_Date Amount

MAPPING
Policy Policy_NO Client_NO(FK) Program_NO (FK) Policy_name Number_of_insured Start_date
(PK) (CLIENTS) (INSURANCE_PROGRAM)
Insurance_program Program_NO(PK) Program_type Program_name
Classes Class_name Class_No
Classes_Has coverage Class_No Program_No Service_No
Clients Client_No(PK) Client_name Client_type Client_Address
subscriber Subscriber_ID Client_NO(FK) HOF_IDRecursive Installment Height Weight Signature

(PK) (CLIENTS) (m-m) relation
Insurance_Claim Claim_No(PK) Subscriber_No(FK) HCP_NO(FK) Visit_Date Ammount

(Subscriber) (HCP
Service)
HCP Services HCP_NO(PK) Service_NO(FK) (Services) HCP_Name
Classes Class_NO(PK) Class_Name
Services Service_NO(PK) Service_Name

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.
Create table clients

{
CLIENT_TYPE number unique,
CLIENT _NO number primary key,
CLIENT _NAME varchar2(20),
P_O_BOX varcar2(20) ,
ADDRESS varchar2(20),
Tel_no number(5)
};
Create table subscriber

{
CLIENT _NO number(5),
SUBSCRIBER_ID number(5) primary key,
NATIONAL_NO number(5) unique,
F_NAME varchar2(20),
M_NAME varchar2(20),
L_NAME varchar2(20)
DATE_OF_BIRTH date,
GENDER number(5),
SOCIAL_STATUS number(5),
NATIONALITY number(5),
PROFESSION number(5),
HIGHT number(5),
WIGHT number(5),
PHOTO varchar2(50),
SIGNITURE
INSTALLMENT number(5),
START_DATE date notnull,
END_DATE date notnull,
RELATION_TO_HOF number(5),
HOF_NO number(5),
Constraint c_N fk forign key(CLIENT _NO) refernces clients (CLIENT _NO)
};
Create table medical history

{
SUBSCRIBER_ID number(5) primary key,
SERIAL number(5) primary key,
SERIAL number(5),
DATE date,
DESCRIPTION varchar2(20),
};

Create table insurance policy

{
POLICY_NO number(5) primary key,
CLIENT_NO (FK)
START_DATE date,
END_DATE date,
PROGRAM_NO ,
POLICY_NAME varchar2(20),
NUMBER_OF_INSURED number(5),
Constraint P_N fk forign key(Program_NO) refernces Insurance_program (PROGRAM_NO ),
Constraint C_N fk forign key(CLIENT_NO) refernces clients (CLIENT _NO )
};
Create table health care provider

{
HPC_NO number(5) primary key,
HPC_NAME varchar2(20),
};
Create table services

{
SERVICE_NO number(5) primary key,
SERVICE_NAME varchar2(20),
};
Create table HCP Services

{
HCP_NO number(5) primary key,
};
Create table Insurance_program

{
PROGRAM_NO number(5) primary key,
PROGRAM_TYPE number(5),
PROGRAM_NAME varchar2(20),
};

Create table insurance claims

{
CLAIM_NO number(5) primary key,
SUBSCRIBER_NO number(5),
HCP_NO number(5),
TREATMENT_DATE date,
CLAIM_DATE date,
CLAIM_AMOUNT number(5),
VISIT_DATE date,
Constraint S_N fk forign key(SUBSCRIBER_NO) refernces clients (SUBSCRIBER_ID),
Constraint H_N fk forign key(HCP_NO) refernces HCP Services (HCP_NO),
};
Create table classes

{
CLASS_NO number(5) primary key,
CLASS_NAME varchar2(20),
};
Create table coverage

{
PROGRAM_NO number(5) primary key,
CLASS_NO number(5) primary key,
COVERAGE_PCT number(5) ,
};
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.

TEAM CONTACTS (GROUP#01)

a. Ahmad Al-Musallami, AMusallami@Hotmail.com / AMusallami@Idealsoft.com.jo
b. Alaa Darawsheh, Alaa_Darawshed@Yahoo.com
c. Raed Al-Namrouti, Raed_AlNamrouti@Hotmail.com
d. Murad Sabri, MuradSabri@Yahoo.com
e. Mohammad Abu-Khadegeh, MAbuKhadegeh@Yahoo.com

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.
*** *** ***

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Arab Academy for Banking and Financial Sciences

Advanced Data Base

Health Insurance Project

Prepared by Group#01 Team:

• PROJECT INDEX ........................................................................................................................ 2

ADB Project v1.7.doc 2/19 01/06/2006-03:30 PM

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MINI WORLD DESCRIPTION(1)

 First – Insurance Application:

- Determination of the insurance type (program) required (inpatient or outpatient, both

 Second – Insurance Policy:

A file must be kept for each insurance policy, containing:

 Third – Insurance Subscriber:

Subscriber record should show the relation to the Policy:

 Forth – Visit Claims:

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ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

Health Care Provider(HPC):

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

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ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ATTRIBUTE FORMAT KEY TYPE DESCRIPTION

ADB Project v1.7.doc 10/19 01/06/2006-03:30 PM

Address HCP_No HCP_Name

Hieght Service_No Service_Name

Claim_No Claim_Date Visit_Date Amount

ADB Project v1.7.doc 11/19 01/06/2006-03:30 PM

Insurance_program Program_NO(PK) Program_type Program_name

Classes Class_name Class_No

Classes_Has coverage Class_No Program_No Service_No

Clients Client_No(PK) Client_name Client_type Client_Address

subscriber Subscriber_ID Client_NO(FK) HOF_IDRecursive Installment Height Weight Signature

Insurance_Claim Claim_No(PK) Subscriber_No(FK) HCP_NO(FK) Visit_Date Ammount

HCP Services HCP_NO(PK) Service_NO(FK) (Services) HCP_Name

Classes Class_NO(PK) Class_Name

Services Service_NO(PK) Service_Name

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Create table clients

Create table subscriber

Create table medical history

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Create table insurance policy

Create table health care provider

Create table services

Create table HCP Services

Create table Insurance_program

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Create table insurance claims

Create table classes

Create table coverage

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TEAM CONTACTS (GROUP#01)

First – Insurance Application:

Second – Insurance Policy:

Third – Insurance Subscriber:

Forth – Visit Claims:

* * ***