Out-of-pocketlimitexclusionsPrimarycare visitin-networkcostpreferredbrand RXout-of-network costIn-networkUrgentCare visitcostIn-networkimagingcostHospitalstay in-networkcostspecialistvisit in-networkcostin-networkdurablemedicalequipmentcostIn-networkinpatientmentalhealth staycostPlanTypespecialistvisit out-of-networkcostnon-preferredbrand drugsin-networkcostin-networkphysician/surgeonfeesdo yourequire areferral tosee aspecialist?IndividualDeductibleOut-of-networkskillednursing costCoveragePeriodhospitalstay out-of-networkcostfamilydeductibleIn-networkout-of-Pocketlimitout-of-networkemergencyroom visitcostnon-preferredbrand drugsout ofnetwork costGenericdrugs in-networkcostOut-of-networkdiagnosistest costcoinsuranceforanesthesiaIn-networkpreventativecare/screeningcostservicesnotcoveredby planemergencymedicaltransportationin-networkcostspecialtydrugs in-networkcostOut-of-networkout-of-pocket limitIn-networkOutpatientMentalhealth carecostOut-of-pocketlimitexclusionsPrimarycare visitin-networkcostpreferredbrand RXout-of-network costIn-networkUrgentCare visitcostIn-networkimagingcostHospitalstay in-networkcostspecialistvisit in-networkcostin-networkdurablemedicalequipmentcostIn-networkinpatientmentalhealth staycostPlanTypespecialistvisit out-of-networkcostnon-preferredbrand drugsin-networkcostin-networkphysician/surgeonfeesdo yourequire areferral tosee aspecialist?IndividualDeductibleOut-of-networkskillednursing costCoveragePeriodhospitalstay out-of-networkcostfamilydeductibleIn-networkout-of-Pocketlimitout-of-networkemergencyroom visitcostnon-preferredbrand drugsout ofnetwork costGenericdrugs in-networkcostOut-of-networkdiagnosistest costcoinsuranceforanesthesiaIn-networkpreventativecare/screeningcostservicesnotcoveredby planemergencymedicaltransportationin-networkcostspecialtydrugs in-networkcostOut-of-networkout-of-pocket limitIn-networkOutpatientMentalhealth carecost

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