In-networkinpatientmentalhealth staycostCoveragePeriodIn-networkout-of-Pocketlimitnon-preferredbrand drugsout ofnetwork costIn-networkpreventativecare/screeningcostnon-preferredbrand drugsin-networkcostspecialistvisit out-of-networkcostpreferredbrand RXout-of-network costfamilydeductibleOut-of-networkout-of-pocket limitout-of-networkemergencyroom visitcostOut-of-networkskillednursing costPlanTypecoinsuranceforanesthesiaemergencymedicaltransportationin-networkcostin-networkphysician/surgeonfeesdo yourequire areferral tosee aspecialist?specialtydrugs in-networkcostGenericdrugs in-networkcosthospitalstay out-of-networkcostIn-networkimagingcostIn-networkUrgentCare visitcostIndividualDeductibleservicesnotcoveredby planOut-of-pocketlimitexclusionsHospitalstay in-networkcostPrimarycare visitin-networkcostspecialistvisit in-networkcostOut-of-networkdiagnosistest costIn-networkOutpatientMentalhealth carecostin-networkdurablemedicalequipmentcostIn-networkinpatientmentalhealth staycostCoveragePeriodIn-networkout-of-Pocketlimitnon-preferredbrand drugsout ofnetwork costIn-networkpreventativecare/screeningcostnon-preferredbrand drugsin-networkcostspecialistvisit out-of-networkcostpreferredbrand RXout-of-network costfamilydeductibleOut-of-networkout-of-pocket limitout-of-networkemergencyroom visitcostOut-of-networkskillednursing costPlanTypecoinsuranceforanesthesiaemergencymedicaltransportationin-networkcostin-networkphysician/surgeonfeesdo yourequire areferral tosee aspecialist?specialtydrugs in-networkcostGenericdrugs in-networkcosthospitalstay out-of-networkcostIn-networkimagingcostIn-networkUrgentCare visitcostIndividualDeductibleservicesnotcoveredby planOut-of-pocketlimitexclusionsHospitalstay in-networkcostPrimarycare visitin-networkcostspecialistvisit in-networkcostOut-of-networkdiagnosistest costIn-networkOutpatientMentalhealth carecostin-networkdurablemedicalequipmentcost

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