Primarycare visitin-networkcostservicesnotcoveredby plannon-preferredbrand drugsout ofnetwork costOut-of-pocketlimitexclusionsOut-of-networkdiagnosistest costGenericdrugs in-networkcostnon-preferredbrand drugsin-networkcostin-networkphysician/surgeonfeesemergencymedicaltransportationin-networkcostout-of-networkemergencyroom visitcostPlanTypepreferredbrand RXout-of-network costHospitalstay in-networkcostdo yourequire areferral tosee aspecialist?Out-of-networkskillednursing costfamilydeductiblespecialistvisit in-networkcostIn-networkinpatientmentalhealth staycostcoinsuranceforanesthesiaCoveragePeriodspecialistvisit out-of-networkcostIndividualDeductibleIn-networkpreventativecare/screeningcostspecialtydrugs in-networkcostIn-networkimagingcostin-networkdurablemedicalequipmentcostIn-networkOutpatientMentalhealth carecosthospitalstay out-of-networkcostIn-networkout-of-PocketlimitOut-of-networkout-of-pocket limitIn-networkUrgentCare visitcostPrimarycare visitin-networkcostservicesnotcoveredby plannon-preferredbrand drugsout ofnetwork costOut-of-pocketlimitexclusionsOut-of-networkdiagnosistest costGenericdrugs in-networkcostnon-preferredbrand drugsin-networkcostin-networkphysician/surgeonfeesemergencymedicaltransportationin-networkcostout-of-networkemergencyroom visitcostPlanTypepreferredbrand RXout-of-network costHospitalstay in-networkcostdo yourequire areferral tosee aspecialist?Out-of-networkskillednursing costfamilydeductiblespecialistvisit in-networkcostIn-networkinpatientmentalhealth staycostcoinsuranceforanesthesiaCoveragePeriodspecialistvisit out-of-networkcostIndividualDeductibleIn-networkpreventativecare/screeningcostspecialtydrugs in-networkcostIn-networkimagingcostin-networkdurablemedicalequipmentcostIn-networkOutpatientMentalhealth carecosthospitalstay out-of-networkcostIn-networkout-of-PocketlimitOut-of-networkout-of-pocket limitIn-networkUrgentCare visitcost

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