servicesnotcoveredby planemergencymedicaltransportationin-networkcostPrimarycare visitin-networkcostOut-of-networkskillednursing costIn-networkpreventativecare/screeningcostIn-networkimagingcostIn-networkout-of-Pocketlimitin-networkdurablemedicalequipmentcostOut-of-networkdiagnosistest costnon-preferredbrand drugsin-networkcostPlanTypeHospitalstay in-networkcosthospitalstay out-of-networkcostOut-of-networkout-of-pocket limitspecialtydrugs in-networkcostIn-networkOutpatientMentalhealth carecostpreferredbrand RXout-of-network costspecialistvisit out-of-networkcostnon-preferredbrand drugsout ofnetwork costGenericdrugs in-networkcostout-of-networkemergencyroom visitcostIndividualDeductibleOut-of-pocketlimitexclusionsdo yourequire areferral tosee aspecialist?coinsuranceforanesthesiain-networkphysician/surgeonfeesCoveragePeriodIn-networkinpatientmentalhealth staycostIn-networkUrgentCare visitcostfamilydeductiblespecialistvisit in-networkcostservicesnotcoveredby planemergencymedicaltransportationin-networkcostPrimarycare visitin-networkcostOut-of-networkskillednursing costIn-networkpreventativecare/screeningcostIn-networkimagingcostIn-networkout-of-Pocketlimitin-networkdurablemedicalequipmentcostOut-of-networkdiagnosistest costnon-preferredbrand drugsin-networkcostPlanTypeHospitalstay in-networkcosthospitalstay out-of-networkcostOut-of-networkout-of-pocket limitspecialtydrugs in-networkcostIn-networkOutpatientMentalhealth carecostpreferredbrand RXout-of-network costspecialistvisit out-of-networkcostnon-preferredbrand drugsout ofnetwork costGenericdrugs in-networkcostout-of-networkemergencyroom visitcostIndividualDeductibleOut-of-pocketlimitexclusionsdo yourequire areferral tosee aspecialist?coinsuranceforanesthesiain-networkphysician/surgeonfeesCoveragePeriodIn-networkinpatientmentalhealth staycostIn-networkUrgentCare visitcostfamilydeductiblespecialistvisit in-networkcost

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