Hospitalstay in-networkcostPlanTypeIn-networkimagingcostout-of-networkemergencyroom visitcostOut-of-networkdiagnosistest costpreferredbrand RXout-of-network costin-networkphysician/surgeonfeesIn-networkOutpatientMentalhealth carecostOut-of-pocketlimitexclusionsIn-networkinpatientmentalhealth staycostnon-preferredbrand drugsin-networkcostspecialtydrugs in-networkcostemergencymedicaltransportationin-networkcostCoveragePeriodspecialistvisit in-networkcostin-networkdurablemedicalequipmentcostIn-networkUrgentCare visitcostdo yourequire areferral tosee aspecialist?Out-of-networkskillednursing costIn-networkout-of-PocketlimitfamilydeductibleOut-of-networkout-of-pocket limitGenericdrugs in-networkcostnon-preferredbrand drugsout ofnetwork costhospitalstay out-of-networkcostcoinsuranceforanesthesiaIndividualDeductiblespecialistvisit out-of-networkcostIn-networkpreventativecare/screeningcostPrimarycare visitin-networkcostservicesnotcoveredby planHospitalstay in-networkcostPlanTypeIn-networkimagingcostout-of-networkemergencyroom visitcostOut-of-networkdiagnosistest costpreferredbrand RXout-of-network costin-networkphysician/surgeonfeesIn-networkOutpatientMentalhealth carecostOut-of-pocketlimitexclusionsIn-networkinpatientmentalhealth staycostnon-preferredbrand drugsin-networkcostspecialtydrugs in-networkcostemergencymedicaltransportationin-networkcostCoveragePeriodspecialistvisit in-networkcostin-networkdurablemedicalequipmentcostIn-networkUrgentCare visitcostdo yourequire areferral tosee aspecialist?Out-of-networkskillednursing costIn-networkout-of-PocketlimitfamilydeductibleOut-of-networkout-of-pocket limitGenericdrugs in-networkcostnon-preferredbrand drugsout ofnetwork costhospitalstay out-of-networkcostcoinsuranceforanesthesiaIndividualDeductiblespecialistvisit out-of-networkcostIn-networkpreventativecare/screeningcostPrimarycare visitin-networkcostservicesnotcoveredby plan

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