Hi Barry,
We can get started with some concepts however please consider this discussion confidential.
And I�ll use NewCo for the name of our startup business entity.

�Similar to US health insurance company, but greatly simplified
�Operating in the dental space to start, no medical.
Our coding will be using CDTs for procedures
�NewCo will offer a set of plans (3 to 5) which are tailored for various scenarios, basic, complete, periodontics, etc.
where each plan will offer certain procedures for free, the remaining procedures will be charged at an agreed upon discount, call this a fee schedule.

�Will have providers (dentists) and practices (one or more providers).
We are also calling these Practice Group or Group.

Providers can work at multiple practices and we need to verify the credentials of each provider and the practice.
�A practice will offer one or more plans that we white label and manage.
Each plan offers procedures at an agreed upon cost based on the geolocation of the practice (zip code prefix)

�NewCo has a proprietary database that has procedure pricing data for the US
�There will be members, members can have dependents
�Members will subscribe to a plan that is offered by practice.
There is a monthly subscription fee based on the type of plan which NewCo processes and pays the practice less a processing fee
�Members will visit a practice to get something done.
This results in a claim generated by the practice and sent to NewCo.
NewCo will process the claim and charge the member�s credit card for the amount, then pay the provider.

As part of this practice will preauthorize the procedures being done, usually done at the practice front-desk prior to the encounter.
This results in a hold being placed on the member�s credit card
�NewCo will charge an additional fee for major procedures (determined by price, think $300 and up).
This is part of processing the claim from the provider
�We will need to adhere to HIPAA regs, this means encryption in the database but at this point we want to get the DB model down first
�Using MySQL and there will be an API

I�ve browsed several of your posted models, the person master index for example, as well as the insurance-oriented ones.
I think there�s a lot of cross over but we are combining a few of these.
In any case it�s my hunch that you are very comfortable with this sort of model.

Please take a look and let�s discuss further, note that we are well funded and are in requirements and design phase now.

Regards, Mark