When anti-Kappa Dean Cathy Munsch decrees that sorority pledging must be open to all students, and not just the school’s silver-spooned elite, all hell is about to break loose, as a devil-clad killer begins wreaking havoc across the campus.

With Halloween just days away, Dean Munsch makes an announcement affecting the campus and, specifically, Chanel's plan to throw a pumpkin patch party in support of her Kappa Kappa Tau presidential campaign. Meanwhile, Grace and Pete lead a search party for a missing friend, which steers them closer to the Red Devil than ever before, and Chanel #3 and #5 learn what life would be like without Chanel.

Shocking confessions are made as the Red Devil is finally unmasked and the killer revealed.

Years after the murderous events at Kappa House, Dean Munsch purchases an abandoned hospital under the guise of fixing the healthcare system in America. After recruiting surgeons, Dr. Brock Holt and Dr. Cassidy Cascade, as well as medical student Zayday Williams, the Dean shocks everyone when she enlists the services of the disgraced Chanels to join the ranks at the teaching hospital. Meanwhile, secrets from the hospital’s past begin to reveal themselves and a new killer surfaces.