Devoted SC MAPD Summary of Benefits

DEVOTED PREMIUM 003 SC (HMO) - H3041-003-000

DEVOTED CORE 001 SC (HMO) - H3041-001-000

DEVOTED CHOICE MA ONLY 003 SC (PPO) - H7028-003-000

DEVOTED CHOICE GIVEBACK 002 SC (PPO) - H7028-002-000

DEVOTED CHOICE 001 SC (PPO) - H7028-001-000

DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) - H7028-005-000

DEVOTED C-SNP CHOICE PLUS 006 SC (PPO C-SNP) - H7028-006-000