Genericdrugs in-networkcosthospitalstay out-of-networkcostcoinsuranceforanesthesiaIn-networkout-of-Pocketlimitspecialtydrugs in-networkcostnon-preferredbrand drugsout ofnetwork costspecialistvisit in-networkcostPrimarycare visitin-networkcostspecialistvisit out-of-networkcostIndividualDeductiblepreferredbrand RXout-of-network costout-of-networkemergencyroom visitcostIn-networkOutpatientMentalhealth carecostIn-networkinpatientmentalhealth staycostOut-of-networkout-of-pocket limitIn-networkUrgentCare visitcostCoveragePeriodnon-preferredbrand drugsin-networkcostOut-of-networkdiagnosistest costservicesnotcoveredby planfamilydeductibleOut-of-pocketlimitexclusionsIn-networkimagingcostin-networkdurablemedicalequipmentcostdo yourequire areferral tosee aspecialist?In-networkpreventativecare/screeningcostHospitalstay in-networkcostin-networkphysician/surgeonfeesemergencymedicaltransportationin-networkcostPlanTypeOut-of-networkskillednursing costGenericdrugs in-networkcosthospitalstay out-of-networkcostcoinsuranceforanesthesiaIn-networkout-of-Pocketlimitspecialtydrugs in-networkcostnon-preferredbrand drugsout ofnetwork costspecialistvisit in-networkcostPrimarycare visitin-networkcostspecialistvisit out-of-networkcostIndividualDeductiblepreferredbrand RXout-of-network costout-of-networkemergencyroom visitcostIn-networkOutpatientMentalhealth carecostIn-networkinpatientmentalhealth staycostOut-of-networkout-of-pocket limitIn-networkUrgentCare visitcostCoveragePeriodnon-preferredbrand drugsin-networkcostOut-of-networkdiagnosistest costservicesnotcoveredby planfamilydeductibleOut-of-pocketlimitexclusionsIn-networkimagingcostin-networkdurablemedicalequipmentcostdo yourequire areferral tosee aspecialist?In-networkpreventativecare/screeningcostHospitalstay in-networkcostin-networkphysician/surgeonfeesemergencymedicaltransportationin-networkcostPlanTypeOut-of-networkskillednursing cost

Summary Benefit Card Bingo - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


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  1. Generic drugs in-network cost
  2. hospital stay out-of-network cost
  3. coinsurance for anesthesia
  4. In-network out-of-Pocket limit
  5. specialty drugs in-network cost
  6. non-preferred brand drugs out of network cost
  7. specialist visit in-network cost
  8. Primary care visit in-network cost
  9. specialist visit out-of-network cost
  10. Individual Deductible
  11. preferred brand RX out-of-network cost
  12. out-of-network emergency room visit cost
  13. In-network Outpatient Mental health care cost
  14. In-network inpatient mental health stay cost
  15. Out-of-network out-of-pocket limit
  16. In-network Urgent Care visit cost
  17. Coverage Period
  18. non-preferred brand drugs in-network cost
  19. Out-of-network diagnosis test cost
  20. services not covered by plan
  21. family deductible
  22. Out-of-pocket limit exclusions
  23. In-network imaging cost
  24. in-network durable medical equipment cost
  25. do you require a referral to see a specialist?
  26. In-network preventative care/screening cost
  27. Hospital stay in-network cost
  28. in-network physician/ surgeon fees
  29. emergency medical transportation in-network cost
  30. Plan Type
  31. Out-of-network skilled nursing cost