I thank all of you for coming to join us, as well as those who are joining on the webcast. I'm David Young, the Vice President of Investor Relations at Aflac, yes, Aflac Incorporated. Please note that as part of our green efforts at Aflac, this meeting includes all the materials for today's event on investors.aflac.com. You will find an agenda along with all the slides and other useful information in the appendix of the PDF. Now, as for our agenda, we'll begin our meeting today with a strategic overview of Aflac Incorporated by our Chairman and CEO, Dan Amos. Fred Crawford, President and Chief Operating Officer, Aflac Incorporated, will then address our operating strategy and outlook.
Masatoshi Koide, President and Representative Director of Aflac Life Insurance Japan, will then join us from Tokyo and provide a strategic overview for Aflac Japan and address its growth strategy. Teresa White, President, Aflac U.S., and Virgil Miller, Deputy President of Aflac U.S., will present a strategic overview for the U.S. segment and its growth strategy. We will then have our first break. The first Q&A panel focused on the preceding presentations immediately follows that break. We will also have another Q&A session at the end focused on the second half of presentations, so please hold your questions until those respective panels. We are also live, so I ask that you now take this opportunity to check and silence your cell phones and other electronic devices.
Before we begin today, let me point out that some statements made at today's meeting are forward-looking within the meaning of federal securities laws. Although we believe these statements are reasonable, we can give no assurance that they will prove to be accurate because they are prospective in nature. Actual results could differ materially from those we discuss today. Please look at our latest 10-K for some of the various risk factors that could materially impact our results. I would also note that we refer to certain financial measures that are not calculated in accordance with U.S. GAAP. Our most recent earnings release is available at investors.aflac.com and includes reconciliations of certain non-GAAP measures. Definitions for these non-GAAP measures are included in the appendix. As I mentioned earlier, copies of the slides are also available at investors.aflac.com, so you can follow along and make notes.
At this time, I'd like to introduce our first speaker. Dan Amos has been with the company on a full-time basis since 1973. In 1990, he became CEO of Aflac and Aflac Incorporated, and in 2001, he was also named Chairman. Dan has been named by the Harvard Business Review as one of the 100 best performing CEOs in the world five times. He will now provide a strategic overview of Aflac Incorporated. Ladies and gentlemen, Dan Amos.
Well, good morning, everyone, and thank you for joining us. It's amazing what a difference a year can make. As you'll recall, last year at this time, we conducted our meeting virtually for the second year in a row. There was still a lot of uncertainty around concerning the pandemic. Today, I'm very encouraged that the world appears to be putting it in the rearview mirror. Although we at Aflac were certainly impacted by the pandemic, we continue to take a decisive action to invest in our business, our brand, and laying the foundation for future growth. I am proud of our management team. You'll hear more about the actions that they've taken today from many of the leaders that initiated them.
I know that you've heard me say this before, how I believe that one of the key responsibilities as being a CEO is, in conjunction with the board, is successful succession planning. As we do this, we focus on cultivating a strong bench of leaders to lay the groundwork for seamless transition as well as the continuity and expertise and strategic execution. Developing our leaders is also one of my favorite roles as CEO, and today provides the opportunity for you to hear from them and their strategic plans. Recently, we saw examples of succession planning in action when we announced the two deputy presidents moving into presidential roles in January 2023. Brad Dyslin will assume the role of Chief Investment Officer, and Virgil Miller will assume the role of President of Aflac U.S.
I want to thank Eric Kirsch for his vision, his expertise in building a world-class investment organization. I also want to welcome Brad to his new leadership role. Brad has proven himself as a distinguished leader, collaborating with Eric, Brad, and the team. To deliver strong results since the early days of 2011 when Eric set out to build Aflac Global Investments. I am grateful for Teresa White's 24 years of outstanding service and contribution to Aflac, most recently as President of Aflac U.S. for the last eight years. Like Teresa, Virgil is a prime example of leader cultivated from within our ranks. Virgil has been with Aflac since 2004 in various operational roles. As both Virgil and Brad assumes their new roles, I know that they are well suited to lead Aflac U.S. and Aflac Global Investments forward to deliver efficiencies, innovation and growth.
As for me, I'm now in my 33rd year as CEO. I'm still enjoying what I do, building and cultivating management team to grow the company. Most of you know me, and I will be here today to help answer any of the questions that you may have. But one of my main objectives today is for you to hear from the outstanding leadership team about their areas of focus. As I meet with investors, rating agencies and analysts, I'm often asked two questions. What worries you most? What are you most excited about after 33 years? About what worries me most, I always preface my remarks because I wanna make sure you understand that we have to make our corporate objectives. Otherwise, that's all we'll be discussing today. What I'd like to say is I'm always concerned about growing the top line, especially post-pandemic.
Although I do feel much better about 2023, given our sales performance in 2022, and the fact that we're building momentum to end with a strong year. Through the years, I've always been excited that Aflac has generated such strong financial performance and adapted to all types of macro environments. Whether it be a weak yen or a strong yen or inflation environment or a deflation environment, or numerous other things that we have no control over. It is our people who have adapted to make the results happen. As you know, the pandemic was a challenging time for everyone, whether at home or at work. Obviously, questions remain as to what will be the lasting impact of the pandemic and how might it impact work site enrollments in the U.S. and the ability to resume face-to-face sales in Japan.
Like many companies, we have workers who are on site, they're remote, and they're hybrid. I know that all of us, including me, wonder, "Is this going to be the new norm?" I'm sure that you've heard me talk about the importance of face-to-face sales in our sales process, and I think the same holds true for our working environment. As human beings, we are social creatures, and I think that there are mental benefits and efficiencies that come with being in the office. Over the last month or so, we have hosted events at our offices in the U.S. to encourage our employees to return to work and to reconnect with their teammates. It has been working for us, I must say. Most importantly, it leads me to believe that our sales will finish strong in 2022.
We also believe that we have the right strategy to close the gap that so many Americans face when a medical event occurs. As Virgil will tell you, he is confident that 2023 will be another good sales year, and that it will surpass our goal of $1.8 billion in annual new sales by 2025. As I mentioned on our last earnings call, I have taken two trips to Japan in the last several months. I noticed that life is gradually returning to normal. Japanese citizens are still wearing masks everywhere, but that's always been part of their culture. A strong signal of life going back toward normal was the successful launch of our new cancer insurance product. On my last or most recent trip to Japan, I spent considerable time listening to associates and the needs that they had in five different cities across Japan.
I returned quite energized by what I heard from the sales associates. In my previous trips to Japan, I met with the executive leadership of Japan Post Group. I think that our collaboration has set them up to do well when we begin the selling of the new cancer product in the second quarter of 2023 for Japan Post. Koide-san is the president of Aflac Japan for five years now and is doing an outstanding job in his role. He will explain how both product and distribution fit into the near term strategic growth plans to be the leading company, or as they call it, creating Living in Your Own Way in Japan. In both the U.S. and in Japan, we have broadened our product lines.
For example, in the U.S., we are excited that for every 100 network, dental and vision policies that we sold in 2022, we have sold over 50 core supplemental health products. That program is working. In addition, just last week, we also announced the expansion of the alliance with Trupanion through a joint venture in Japan. These examples highlight our acquisitions and expanded product line portfolio in both countries have real potential to open the door for our business. Fred is doing a fine job as he rounds out his third year as President and Chief Operating Officer. He has been effective in his leadership, collaborating with investments. As investments continue to do well, Brad started concentrating on operations when he became Chief Operating Officer. This includes executing on the enterprise strategy for growth that we laid out two years ago.
In addition to successfully navigating the pandemic impact, this strategy reinforces our platforms for sales growth. In 2023, Brad will be increasing his focus on Japan as well as spending more time over there. One of his critical areas of focus is to reduce expenses through efficiencies and value creation while growing the top line. Brad will update you on his progress. I mentioned inflation earlier, and everyone is concerned about inflation. I was around in the mid-1970s, so I know inflation can stress people's pocketbooks. However, I believe that regardless of whether you have universal health care like Japan or the best major medical insurance in the U.S., there is no plan that is designed to cover all the out-of-pocket expenses. That's where our products come in.
I can let you know that and rest assured that, the challenges and the environment that we see going forward, that our global investment team follows a disciplined investment process with strong risk management and operating within the strategic asset allocation. I believe that we will continue to benefit from our investment management approach under Brad's leadership for many years to come, and he will provide an update later today. The second question was. What are you most excited about? I would have to say that the last five years, it's overall job that we've done with capital deployment and liquidity, and specifically how well we've adapted in that environment. Many of you have even told me the same thing. Max, who has now been CFO for three years, has done an exceptional job navigating the challenging environment and the weakening yen while positioning the company for future success.
Keep in mind, even after the last couple of years, I am thrilled that we still are among the highest return on capital and the lowest cost of capital in the industry. Max will cover more of this later. Let me just say that we work hard to maintain strong capital ratios on behalf of the policyholders, both in the United States and in Japan, while at the same time remaining tactical in our deployment of capital. I hope you saw last week's announcement that we've increased the first quarter 2023 dividend by 5%. This increase follows a nearly 84% increase in the annual dividend over the past five years. Our 40th consecutive year track record is supported by the strength of our capital and our cash flows.
Year to date, Aflac Incorporated deployed $1.8 billion in capital to repurchase 30.3 million shares of our stock. Combined with dividends, that means we delivered $2.6 billion back to the shareholders for the first nine months of this year. All of this is to say that I'm very pleased with what Max has accomplished throughout a very challenging period. The job never ends, so I'm counting on him and our management team to look ahead to the accomplishments for the future. As I've said, we're looking to emerge from the pandemic with our company in a position of strength, and I believe we've done that. We are continuing to build on leading position in Japan and in the United States. We believe Aflac's powerful brand and wide-reaching distribution will boost our ability to be where people want to purchase insurance.
My job as CEO is to run the company to achieve strong results, and it really doesn't stop there. My job is also to ensure Aflac is a trusted, respected, and powerful brand. I don't think it's coincidental that Aflac has achieved our level of success while focusing on doing the right things. In fact, I believe they go hand in hand. I'm proud of what we've accomplished in balancing both our purpose and our earnings performance, which results in strong shareholder return. Doing the right thing is the approach Aflac has taken far back, before I can even remember. For 27 years, the Aflac family has been giving back to the Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta with more than $162 million in donations, half of that coming from our field force who made their own personal donations.
In fact, in the last two weeks, or in the next two weeks, I will be returning here to participate in the New York Stock Exchange global giving campaign, where members of the companies raise awareness for organizations that we all support. In Japan, through the Aflac Parents House, we've also helped more than 140,000 children and their families who are facing cancer and other diseases. I find that people want to be associated with companies that do the right thing, and we look to continue doing so. At Aflac, we manage our business for the long term while remaining focused on achieving the near-term financial objectives. As a management team and as CEO, we are dedicated to addressing the challenges of growth. Our approach to driving long-term shareholder value is straightforward, pursuit of growth, strong pre-tax margins, and tactical capital deployment.
Despite the headwinds that we've faced over the last couple of years, I believe that our operations are on solid footing. This is directly due to the resolve of our people and the way we leverage the technology in the current environment and the underlying need for our products in both markets. I believe we are now approaching the end of COVID, but I've been reflecting back on that February 13th board meeting and the month before the pandemic hit. That is when our board member, Dr. Barbara Rimer, who was Dean of the School of Public Health at the University of North Carolina, she solemnly looked at me and conveyed how serious the pandemic was gonna be. She emphasized that the pandemic would last for several years, and a lot of people were gonna die.
At that time, it was so hard for me to comprehend exactly what she was talking about and the extreme gravity and the protracted time that would follow. At the same time, it was so hard for me to believe that we could turn the tide and be ready for something like that. As we navigated our way through the extreme environment, it was also impossible to predict how well our people, our company would adapt. I am very proud of the management team and what we've accomplished. Those of you that are here today that know me, know that I like to talk about balance, but in a world of what have you done for me lately, it's important to celebrate those accomplishments, but even more important to look to the future.
On that note, you're about to hear what I would say is what we expect to achieve in the future. Let me turn the program over to Fred, who will do just that. Thank you very much for coming. Fred?
Thank you, Dan. Good morning. Good to see you all live, and welcome to those of you who are joining us virtually this morning. In 2020, we completed an enterprise strategic review and began executing in 2021. We are now focused on transitioning from investment to realization. I'd characterize our strategy as leverage, build, and explore. While these are components, there are components of all three of these things in each of our businesses. You can generalize when looking at Aflac Japan, Aflac U.S., and our enterprise efforts, including Aflac Global Investments. In Japan, we are leveraging our platform to expand our third sector portfolio to sell to both our existing and new customers. When you serve nearly 15 million individual policy holders and their families, you'll naturally see opportunity in your own book.
While actively working on growth initiatives, the math can be daunting when looking at high penetration rates and the competitive landscape. However, as a supplemental health and cancer insurance provider, there are positive catalysts related to an aging population and the shifting of health and welfare expenses onto individuals. We are also very mindful of Aflac Japan's essential value to the enterprise, generating deployable capital and lowering our overall cost of capital. We are building in the U.S. and have invested approximately $575 million in both acquisitions and build capital associated with dental and vision, group life and disability, and direct to consumer. We naturally see more blue ocean opportunity in the U.S., given the low penetration of voluntary products, our Buy- to- Build acquisitions, and a more robust economy.
At the corporate level, we entertain strategic investments and form alliances that create options and opportunities that often fall just outside our core, but still leveraging our brand, our scale, and our distribution. We are disciplined in terms of the amount of capital we place at risk and require a strategic connection to our core platforms. Earlier this year, we launched an enterprise effort designed to ensure strong execution in realizing the benefits associated with larger scale and often long-term investments. This was in recognition of the increased pace of investment associated with recently acquired or incubated businesses, modernizing our technology and streamlining our operations. This is also aligned with adopting a value of new business approach, ensuring we hit our pricing returns and consistently develop economic value over the long term. With that overview, let's dive a little bit deeper.
We are addressing recovery in Japan through product refreshment and development across First Sector, Third Sector, and select short-term products, such as our recent announcement on pet insurance. Cancer will be further enhanced and expanded early in 2023, with plans to refresh our medical product later in the year. While in its infancy, we see Hatch Healthcare as a foundation to develop, partner, and acquire service capabilities that leverage off our leading position in cancer and our building position in elderly care. One of our main objectives going forward is not just to write new policies, but also create new policy holders, especially among the younger generation.
For example, we now know that if we are selling a small life insurance product with a savings component, like WAYS or child endowment, it ultimately increases our new policyholder base and, more importantly, leads to the sale of third sector products. In fact, we have traditionally seen 25% cross-sell of third sector products at point of sale through the associates channel, and this increases to 50% cross-sell within the first five years after issue. This contained approach to First Sector savings solutions, leveraging our associates channel, addresses the need for retirement savings and income as long-term rates begin to recover. We have priced these products to generate an acceptable return when incorporating proven cross-sell experience. From an operating perspective, our plan calls for driving down expenses over the next five years by increasing the adoption of digital applications, customer service and claims management.
The Japanese insurance industry, in its entirety, and Aflac included, are heavily dependent on paper forms, which results in higher costs, longer response times, suboptimal customer experience, and even business recovery considerations. Moving digital adoption up to the levels enjoyed in the U.S. takes time and investment. However, we expect our investments to yield growth in sales while defending our low expense ratios and delivering industry-leading pre-tax margins throughout this period of transformation. Turning to the U.S., our core small business agent-driven model was impacted by COVID and continues to be impacted by a shifting labor market. A renewed focus on recruiting, product development, small business broker alignment, and adoption of technology tools are all expected to support future growth. This is really blocking and tackling. We are seeing progress in bringing back this core platform and competitive differentiator in the U.S. benefit space.
From a build perspective, we have fully integrated, launched, and moved into growth mode in network dental and vision, group life and disability, and leave management and our D2C platform. These properties are now focused on better aligning to take full advantage of our new capabilities and help drive our core voluntary business. It's not well understood that both businesses also include third-party administration. In our life and disability business, it's leave management services, which includes our Connecticut Paid Family and Medical Leave contract. In network, dental, and vision, it's the Medicare administration business we acquired, along with serving larger companies who often self-insure but need the network and an administrator. These are classic fee-based businesses that need to be understood separately from traditional risk-bearing lines of business and where we have made material platform investments.
We are focused on bending the expense ratio curve over the next five years, moving from the 40% range into the mid-30% range via earned premium growth and as the pace of investment naturally calms down. Finally, we carve out a portion of our deployable capital to invest in incubate businesses that leverage our core franchise strengths. These include strategic investments in specialized asset managers as part of our Aflac Global Investments, our pet insurance alliance with Trupanion, greenfield and incubated businesses like Hatch Healthcare in Japan, and venture investments through our $400 million Insurtech Fund. In total, we have committed or invested approximately $545 million over the last five years. I wanna briefly share our perspective on ESG.
If your focus as a company on sustainability and diversity is just now becoming prominent in your strategy, you're arguably late to the game. In our case, we've had a committee of the board of directors dedicated to what today is called ESG, dating back to 2009. The increased focus on ESG does not represent a dramatic change in practice for Aflac. We believe your ability to have an impact on the climate, diversity and equity and inclusion, and the broader community is only as good as the performance of the company. We are focused on driving the metrics that drive shareholder value. Why? Because that's obviously good for our shareholders, but also good for our ability to consistently invest in ESG. We are committed to sustainability and have built a framework to drive towards net zero emissions by 2050.
Taken together with the remaining proceeds of our inaugural sustainability bond, we have committed and funded an incremental $800 million in sustainable and DEI investments thus far in 2022. This is in addition to over $800 million of investments in sustainable infrastructure, debt, and economic empowerment zones committed to last year. We have a strong diversity in leadership numbers in the U.S. and have an industry-leading and admired women in leadership program in Japan. Finally, we have tied our ESG efforts to management compensation. I have listed some of the metrics we hold ourselves accountable for. Any increase in incentive compensation requires achieving 100% of these metrics. Our formula for driving shareholder value is straightforward. We understand that growth, as measured by currency neutral revenue, has stagnated in recent years.
There are realities related to the interest rate environment, market dynamics in Japan, and operating as a market share leader facing increased competition. I believe we've struck the right balance of investing in our U.S. model, refreshing our product in both the U.S. and Japan, and engineering an investment strategy that positions us for future growth. While executing on these strategies, we continue to deliver on industry-leading margins and returning capital to shareholders at levels materially higher than what we've seen historically. When operating in risk businesses and a seller's market for acquisitions, growth requires patience associated with pricing discipline, time to incubate, test, build, and develop. We know we need to deliver top-line growth, and we are beginning to turn the corner.
With that general overview, I wanna commence with the program so we can get into more details both in Japan and the U.S. and, of course, end with Max on some of the financial backing to the strategy. With that, I'd like to turn the program over to Koide-san in Japan. The team there is joining us from our offices in Japan, and Koide-san will lead us through a discussion on Aflac Japan. Koide-san, let's turn to the video.
Today, I will discuss Aflac Japan's strategies for growth as we aim to drive sales in a post-pandemic environment and further strengthen Aflac Japan's position as the leading company for creating Living in Your Own Way. COVID-19 transformed Japan's business environment and was a stark reminder of the need for protection against severe financial burdens that may arise from a health event. Although the pandemic drew focus away from Japan's rapidly aging population and a declining birth rate, these long-term demographic trends continue to put pressure on Japan's Social Security and universal healthcare systems. To address these long-term trends, policy makers are seeking to shift Japan's Social Security system to one that benefits and supports all generations equally, and the government has commenced discussions to ensure sustainability. Against this backdrop, the public recognizes the forthcoming need to shoulder a greater financial burden for healthcare and medical expenses.
This dynamic is contributing to greater customer need for third sector or protection type insurance products, and is driving the growth potential in Aflac's core business areas. Aflac Japan is the leader in Japan's growing third sector, which includes cancer, medical, and nursing care insurance. The third sector grew over 2.5 times since 20 years ago, and now includes more than 68 million in force policies. Of those policies, approximately 25 million are for standalone cancer insurance, and 43 million policies are medical insurance as of March 31, 2022. Overall insurance penetration in Japan is high. According to industry data, over 82% of Japanese citizens are enrolled in some form of life insurance, and approximately 73% of citizens enrolled in some form of medical insurance.
There are roughly 1.7 times as many medical policies in force as there are cancer policies, and the medical insurance market is increasingly competitive. Cancer insurance, however, has only 43% penetration, and we believe that there is room to grow. Nursing care insurance is expected to grow beyond its current 12% penetration rate. While the overall market size and the penetration for supplemental nursing care insurance is small compared to life, medical, and cancer, we believe it is important to be well-positioned in the nursing care space given the aging population and the likelihood of shifting the burden of the government and to the individual over time. In 2024, Aflac will commemorate its fiftieth anniversary in Japan. To that end, Aflac Japan developed its Aflac Vision 2024 to position the company as the leader for creating Living in Your Own Way.
To achieve this vision, Aflac Japan developed a three-year medium term management strategy which leverages our competitive strengths in talent, strategy, and risk management. The midterm strategy consists of five core strategies and is designed to further solidify Aflac Japan's position as the third sector market leader, expand into new business frontiers consistent with our core capabilities and values, and cultivate an innovation-driven corporate culture. We believe that people are our most important asset, which is why our midterm strategy places talent at the top. We are focused on getting the right people in the right places at the right time with the necessary skills, experience, and knowledge to drive our business into the future. To do so, we rolled out a new job-based human capital management system and are developing talent to lead us through a digital transformation.
We are at the forefront of promoting women in leadership, and we are widely recognized by key publications in Japan for our diversity initiatives. Our focus on talent is well aligned with the government's focus on creating a new form of capitalism, which includes talent development and diversity among its key priorities. Aflac Japan also aims to address changing customer and societal needs by leveraging its huge policyholder base, nearly 50 years of experience, and deep insight to create an ecosystem for Living in Your Own Way. The ecosystem will be developed based on our core values and will address societal issues in a manner that drives our core business, namely cancer, medical care, and nursing care insurance. To that end, Aflac Japan is creating a framework that aligns products and services so that stakeholders can partner to comprehensively meet customer needs.
Aflac Japan's new cancer insurance product, WINGS, which launched in August, and the service integrated insurance being rolled out in January, are concrete first steps toward creating a cancer ecosystem, which will better meet customer needs and further differentiate Aflac Japan from the competition. I will share more about this service integrated insurance in a moment. Risk management and governance are the foundation for Aflac Japan's decision-making and operational agility. Through quarterly monitoring of our management strategies and tactics, Aflac Japan constantly analyzes the business environment and adjusts so that resources can be put to their most effective use in a timely manner. The company's execution of its business continuity and transformation plan in response to the COVID-19 pandemic is an excellent example of how our risk management and governance framework enabled real-time adjustment in the face of rapid change.
Aflac Japan's adoption of agile methodologies and our digital transformation, including paperless initiatives and business process modernization, are other examples of how our risk management of governance frameworks have supported strategy implementation by balancing risk control and risk-taking. Regarding products, Aflac Japan aims to have a full product line up to meet customer needs during any life stage. For potential young and middle-aged customers, Aflac Japan will address their need to build assets with refreshed First Sector products, WAYS, and child endowment. Converting younger people to Aflac customers earlier in life also sets up an easier introduction to our third sector products when the need becomes greater. In the third sector, income support insurance aims to protect those who are in their productive years, whereas nursing care offers protection to those in retirement.
We will continue to develop and grow these newer product areas while continuing to enhance our core cancer and medical products. As I mentioned earlier, Aflac Japan rolled out a new cancer product, WINGS, which is characterized by competitive premiums and expanded coverage for the latest cancer treatments, including cancer screening. Wings will also provide coverage opportunities for cancer survivors. Since its August launch, Wings has helped drive cancer insurance sales, leading to a 32.6% increase in the third quarter. We expect this positive sales momentum to continue into 2023 as Dai-ichi Life and financial institutions begin offering the product in January 2023, and Japan Post Group in the second quarter of 2023. In January, we will begin offering service integrated insurance utilizing a comprehensive concierge service called Aflac Yorisou Cancer Consultation Support.
The service will be offered to policyholders battling cancer and will help take people from diagnosis through treatment and recovery. The concierge will offer 32 services, including facilitating second opinions, counseling, dietary support, and more. The services were test piloted and have been well-received. Aflac Japan's distribution strategy is to provide customers with products when and where they want to purchase insurance. Our extensive distribution platform enables us to reach customers nationwide through agencies, both exclusive and non-exclusive alliance partners, including banks, Dai-ichi Life, Daido Life, and the Japan Post Group, with which we have a strategic alliance. Our distribution network is one of Aflac Japan's competitive advantages. Aflac Japan is strengthening sales promotion with exclusive and Aflac preferred agencies, which are the mainstay of our business.
We plan to increase the number of sales representatives, improve productivity, and provide further support for management of large agencies with enhanced training and horizontal sharing of best practice to strengthen agent retention and increase sales volumes. Regarding large non-exclusive agencies, Aflac Japan is taking steps to expand its market share by adjusting its sales structure and practice. Strengthening relations to increase and enhance touch points with these agencies that have greater potential to attract younger customers. As part of Aflac strategic alliance with the Japan Post Group, we continue to offer Japan Post Group with its 20,000 postal outlets nationwide, broad sales support. For example, on June 1st, Aflac Japan expanded the number of sales offices dedicated solely to supporting Japan Post Group from 17 - 48 offices.
This new structure is contributing to increased proposal activity, and by leveraging our new cancer insurance product in the second quarter of 2023 and other collaborative initiatives, we expect sales activity through the Japan Post Group channel to continue to accelerate over the coming year. In closing, let me say that in the rapidly changing business environment, Aflac Japan, guided by its clear vision, talent strategy and risk management frameworks, is well-positioned to further strengthen its position as the third sector market leader and become the leading company for creating Living in Your Own Way. Thank you.
Thank you, Koide-san. We will now turn to Aflac U.S., and it's my pleasure to introduce Teresa White, President of Aflac U.S. Teresa joined Aflac in 1998. She was promoted to Vice President of Client Services in 2000 and Senior Vice President in 2004. In 2008, Teresa was promoted to Executive Vice President and named Chief Operating Officer of Aflac Columbus in 2013, and promoted to President of Aflac U.S. in 2014. Teresa is the recipient of a number of awards, including being named to the Forbes 50 over 50 in 2021, and Black Enterprise's list of the most powerful women in corporate America for the third consecutive year in 2019. Ladies and gentlemen, it's my pleasure to introduce Teresa White. Teresa.
Thank you, David. Good morning. I'll begin the Aflac U.S. portion of today's meeting with a macroeconomic view of the market, and then I'll hand off to Virgil Miller, who'll provide an overview of the U.S. strategy and insights into how we are positioning ourselves for the future. In the U.S., core inflation has reached a 40-year high, pressuring family incomes to keep up with basic expenses and increasing the risk of people to lose income temporarily due to illness or injury. To compound this, 58% of Americans believe that they're not able to cover out-of-pocket expenses of $1,000 or more, and this is significantly up from 2021, where it was 46% that stated the same. With these unstable conditions and the rising cost of healthcare, we continue to see employers shift costs to employees through increasing deductibles and share of premiums.
Additionally, we're seeing that mental health concerns are taking a toll on consumers and their families, which was really exacerbated during the pandemic. The mental health crisis is not only impacting employees' home lives, but also work performance. Almost half of workers state that mental health challenges had an impact on their productivity in the past year, a significant increase over 2021. Even during the inflationary period, nine out of 10 consumers believe that supplemental health insurance is more important today than ever before as part of a comprehensive benefits package. Additionally, we continue to see the consumer demand for a seamless digital experience, which is no longer a differentiator for benefits providers, but now a requirement. While Aflac has been faced with challenges in 2022, I'm extremely proud of the way that we've responded to the market trends.
We focused on expanding the Aflac value proposition, and we've positioned Aflac U.S. For growth. We believe Aflac U.S. is well positioned for what we're seeing. We've maintained our leadership position and expect that position to grow as we execute on our growth strategy of protecting our core, scaling our acquisitions, and positioning ourselves for the future. Our mature and progressive product portfolio allows us to meet the customer's needs, while our multichannel distribution model allows us to get to the customer how they prefer. Coupled with our focus on creating an easy experience, we continue to protect our core that has yielded a 29% market share in the supplemental health at the worksite. The group voluntary benefits market continues to grow, representing 78% of our 2021 sales.
Our group voluntary benefits continue to outpace the voluntary market, worksite market with a five-year CAGR of over 14%. To further our strength, Aflac's acquisition of Zurich North America's Group Benefits business, now known as Aflac Group Life, Absence and Disability, as well as Aflac's Dental and Vision, now known as Aflac Benefit Solutions, have diversified our portfolio, placing us on the front page of the benefit solutions for our employers. We're pleased with the progress of our acquisitions performance over the prior and current year, and are optimistic of the potential that we have to continue to scale those properties and position them in the marketplace. At this time, I'd like to introduce Virgil Miller, Deputy President and incoming Aflac U.S. President, who will continue the presentation and provide more insights into our strategy. Virgil?
Thank you so much, Teresa. As you just heard, the marketplace is endlessly changing in response to the various influences that shape it. We remain diligent in our strategic approach by staying aware and ahead of consumer needs and the marketplace trends. As we position our future and assess the market, we're exploring trends that we expect to shape our business. We're seeing traditional group carriers and health insurance leverage product bundling and integrated experiences to gain market share. Customer experiences are increasingly dominated by benefits administration and online enrollment platforms. Investments made in digital solutions to extend reach to new markets and enter the direct-to-consumer industry. Paid family medical leave and other programs continue to gain momentum in state legislatures with the potential to add compliance, complexity, and shift demand. We are assessing each of these trends in our strategic approach.
Our strategy remains focused on ensuring people are better prepared for the benefits health insurance does not cover. We believe our product solutions do exactly that. We have established financial goals as part of our 2025 commitments to our investors focused on growing our business and doing so efficiently. We're leveraging access, participation, and persistency to drive these achievements. As you heard Fred mention, we continue to focus on rebuilding our agent sales force to drive growth in recovering the small business segment. With the aid of veteran producer productivity and a comprehensive recruiting strategy, we believe that we are on the right path. We will leverage our Buy-to-Build acquisitions to increase penetration and grow revenue while also managing our expenses to bend the expense ratio curve. You heard Teresa speak about our key enablers a bit earlier.
They are fundamental to our ability to meet these commitments. With approximately 156 million people in the U.S. in the working population, it would be an understatement to say that growth potential is immense. As you can see, only 24% has access to Aflac at the workplace. We are working with our strategic partners and our sales force to increase our access to those at the work site, while our direct to consumer platform enables us to reach the 16.1 million self-employed and the 102.4 million who do not have access to Aflac today. We continue to execute on our growth strategy to increase penetration with our diverse product mix and our multichannel sales force enabled by our best-in-class experience model.
To further access and penetration, we are leveraging our strengths and our position in the marketplace to demonstrate our value to our consumers. We are utilizing the partnerships of our brokers, agents, and strategic partners to drive education and to reinforce awareness of the benefits available to our policyholders. We aim to increase utilization of these benefits to help Close the Gap with medical expenses. We continue on focusing on delivering an easy customer experience by delivering on innovative technology and digital capabilities. These capabilities allow us the ability to integrate with preferred platforms for employers and deliver a best-in-class experience for our policyholders. As part of the overall strategy to serve the underserved, we have partnered with Champions of Care to help reach potential consumers who are impacted by the medical debt crisis.
As we execute on our strategy, we foresee some internal and external challenges we will need to account for as part of our go-forward plan. With our growth strategy in full swing, we must be mindful of our expense footprint. We believe we have the right strategy in place to grow efficiently. We will hold leadership accountable, and it will be critical to ensure that we are successful. As with the many organizations, the COVID-19 pandemic accelerated our digital roadmap to meet consumer needs. While we are pleased with our overall digital solutions delivered in the past couple of years, we're focused on driving and maintaining adoption as consumer demand shifts within the return to normalcy. The pandemic also changed the labor force on a global level. The shift to remote and hybrid work environments, coupled with the Great Resignation, has changed the dynamics of the labor market.
We will continue to understand these dynamics and how they impact the organization's ability to execute on our strategy. Our strategy is centered on driving digital to create an easy experience for our various constituents. We're delivering ease with enhancements to our mobile apps to give policyholders the ability to complete transactions such as filing a claim and servicing their policies on the go. We have implemented automation at various stages of the customer life cycle. Most recently, we extended our code-based processing technology to several lines of business, automating the adjudication of a claim and enabling our customers to get paid fast. We've also delivered new self-service capabilities to include web bill pay and the functionality to provide customers with estimated completion times for claims. This is under the umbrella of Where's My Claim technology that we recently released. We're also making investments to transform the producer experience.
We've migrated our homegrown enrollment platform, Everwell, to a cloud-based platform, improving stability and application performance. We continue to make enhancements and integrate applications for a seamless experience. We streamlined various onboarding activities, such as our new account setup, by modernizing the experience and digitizing our verification requirements. We've also enhanced the mobile capabilities, allowing our producers to service policyholders on the go. These enhancements include filing a claim on the customer's behalf, retrieving policy data at the touch of a finger, and educating their clients on available benefits to drive utilization. Our digital strategy is the key to delivering our experience and our efficiency in meeting our efficiency commitments. As we've shared our strategy overview, you've heard that Aflac U.S. has made various investments to enhance the customer experience, increase our reach, drive benefit utilization in support of our vision. Earlier, Teresa shared some staggering economic data points.
We cannot ignore these impacts, these factors, and the impact they have on consumers. Our Aflac Care Index among Americans 25-54 years old helps expose how impactful the medical crisis is to these consumers. 46% of insured Americans don't have enough in savings to pay for medical expenses. 25% of insured Americans state they would need to borrow money to pay for medical expenses, furthering their debt. Aflac has made it our mission to help lead the movement of closing the gap on medical expenses. Our Close the Gap initiative was created and launched to educate and advocate the reality of medical debt and those who are impacted. We are partnering with individuals who share this mindset to drive awareness and to help consumers be better prepared for the unexpected.
With personalities such as Coach Prime, Wanda Sykes, and others, we Are hoping to encourage consumers to understand the true impacts of a medical event and hopefully enable them to be better prepared for those expenses. We believe the economic factors discussed today advocate the need for voluntary benefits insurance, and we are encouraged Aflac U.S. Can help Close the Gap with medical expenses by being there for policyholders in their time of need. We appreciate your time, and I look forward to continuing to drive the Aflac U.S. company forward. Thank you so much. I look forward to the transition, and I'll turn the program back over to David Young.
Thank you, Virgil. We'll now take a break. If everybody will plan on being back in here at 9:15 A.M., we'll resume for our first Q&A panel. Thank you.
Joining our presenters, Dan, Fred, Teresa, and Virgil on stage are Steve Beaver, Chief Financial Officer of Aflac U.S., and Todd Daniels, Director and Chief Financial Officer of Aflac Life Insurance Japan. Also joining us virtually from Tokyo are Charles Lake, Chairman and Representative Director, President of Aflac International, Masatoshi Koide, President and Representative Director of Aflac Life Insurance Japan, and Koichiro Yoshizumi, Executive Vice President and Director of Sales and Marketing and Alliance Strategy. Before we begin the Q&A, please raise your hand and wait for a microphone, and before asking your question, please introduce yourself and your firm. Please also limit yourself to one question to allow others an opportunity to ask their questions. We will now begin. Suneet?
Thanks, David. Suneet Kamath from Jefferies. I wanted to start with Japan, and I might be remembering this wrong, but I had thought about 10 years ago when you guys rolled out child endowment in WAYS, there was a cross-selling sort of strategy, I thought, and it. I don't think it worked out as well as you guys thought it would, and maybe it was because of different distribution channels. It sounds like you're rolling out something similar now. What is different this time, and how do you make sure that you get the cross-sell as opposed to just a concentration in WAYS and child endowment?
Yeah. Let me take it and Todd can support me or add in. You have it actually right in the premise of your question. That is, when we sold WAYS at high volumes back again. You're right, about nine or 10 years ago, it was predominantly sold in the bank channel. In the bank channel, there was really two dynamics that came out of that. One was, there was a discounted advanced premium or accelerated premium pricing. As you can imagine, if you're selling in the bank channel and you're effectively, quote, "mining deposits," meaning convincing customers to move out of a deposit and into a whole life product, that increased rate of return for an advanced premium or accelerated premium five-year, 10-year, is attractive.
The second learning that came out of that is there was, in fact, very little cross-sell that came out of the bank channel. That's completely different than the associate channel, the agent channel, where there's much more of a holistic planning dynamic, and of course, they're armed with very good intelligence around cancer and medical. What we found in the associate channel is that when we sold a WAYS or child endowment product, as I mentioned earlier, you had about 25% cross-sell right at point of issue. Because persistency is so high in Japan, you hang on to those very same customers for an extended period of time, and you continue to sell into those customers cross-selling third sector. Our data has proven out.
This is not an estimate, this is actual data, has proven out about a 50% cross-sell over the first five years of the product after issue. What we've done here is a completely different approach. We are not emphasizing the bank channel. You don't have an attractive advanced premium feature, and you're focusing on marketing and developing this through the associate channel per my comments. It's very different. Now, what I would caution everybody is it's a low rate environment still, and it's a yen-based savings product. Those have not really been in favor since the Bank of Japan went to negative interest rates. At the same time, we think to support our distribution channel and support the sale of third sector, it's a reasonable opportunity to move gradually back into the market as rates have recovered.
Later on today, you'll hear Max talk about our reinsurance strategy and the other dynamic that's important with a savings-based product is being able to have reinsurance capacity over time. It may not be necessary, but if it's available, it can help with the returns. Because the big issue with returns and savings products in Japan is a very heavy reserving requirement upfront, and that's what's been the big reason for exiting the market after Bank of Japan. That's calming down now, but that's why we're gonna proceed with caution.
Nigel?
Great. Thanks. Good morning, it's Nigel Dally, Morgan Stanley. With Japan sales to hit the JPY 80 billion target for 2025 implies some pretty substantial growth. Just wanted to get some color as to whether that's likely to be linear between now and 2025, or perhaps a little more back-end loaded. Also, what role Japan Post is expected to make in hitting that target? Thanks.
Koide-san and Yoshizumi-san, just so that you can hear the question clearly, we have gone out with a return to JPY 80 billion in sales, out a few years. The question is, should we expect something of a linear type of growth pattern, or is there something specific or special that's going on that takes you to the JPY 80 billion?
Good morning, everyone. This is Koichiro Yoshizumi of Aflac Japan. I'm in charge of sales and marketing. Now, regards to the scenario towards achieving JPY 80 billion. We are taking multichannel strategy. Within, first of all, the associates channel. That's the agency channel. This associates channel accounts for a large share in sales, and there is a strategy that we are taking for that channel. What we are doing is selecting some of these agencies where we would like to have these agencies' management base strengthened, and we are supporting them. We are making an active investment into these agencies. Since we have been doing this for a while, these agencies that we are supporting is really growing, and they're growing their numbers quite largely.
By increasing the number of these kind of agencies, we would like to increase the volume of sales from the associates channel. Then next is our efforts with the Japan Post Group. Regarding the Japan Post channel or the Japan Post Group, they have resumed their sales, and every quarter they are steadily increasing their sales. Since this channel is a channel with very large potential, what we are doing between Aflac and the Japan Post is to really have a good solid customer first or customer-oriented sales being done.
Yeah, let me, while we're getting them-
2025. That's how we are going to be growing the Japan Post channel. Then the large non-exclusive channel. We are trying to improve the product capability and competitiveness for this channel. We are also thinking of sales recovery in this large non-exclusive channel as well.
Well, what I'd like to add, so first of all, that was a nice sort of walk through the channel-by-channel strategy. To your question, the way I would characterize it, of course, nothing's going to be purely linear, is typically the case. As you know from following us over the years, there's some natural lumpiness that is associated with the launching of new product, particularly medical and cancer, in each year. A few things I would say, when you listen to Yoshizumi-san talk about the various channels, many of those channels are in recovery and development mode, whether it's Japan Post, associates channel.
Also the speed of product renewal and refreshment in, frankly, all of Japan with our competition and now with Aflac, has sped up to where you don't have the environment of two years without a new product and then launching a new product, and you see the pop in sales, then two years without and then launch. It's becoming the case that each and every year we've got what amounts to a product refresh backlog that now includes elderly care, income product, and as rates recover, maybe even including some First Sector type product over time. I would characterize it as a building to the JPY 80 billion. Is it gonna be purely linear? Probably not. But a building dynamic.
Eric?
Thank you. Erik Bass with Autonomous Research. Virgil and Fred both talked about bending the cost curve in the U.S. Couple of questions. First, how quickly do you see getting to that kind of mid-30% expense ratio that you talked about? And then secondly, do you see all of that dropping to the bottom line in terms of improved margin, or is there some offset we should think about with, as you change the product mix and maybe some changes to the benefits ratios?
Sure. I can make a couple comments, but then ask Virgil to comment. Essentially, over the next five years is our plan to bend that curve. When we talk about the 40% we're currently running at and moving down to the mid-30s, you're wise to point out the mix issue. Because when you start building more and more of your earned premium on life and disability and dental and vision, those will tend to change the mix a bit. They tend to be higher benefit ratio, lower expense ratio businesses. During the period of build, they of course run higher on expenses, and they tax our expense ratio.
I think we've commented each quarter that just the build investments alone have taxed our expense ratio by upwards of 2.5 to even 3%. There's a lot of build being done in there. What you're really going to see in terms of bending the curve is you're gonna see a flattening, if you will, of the actual absolute expenses over time, and the build in the revenue or the denominator is what's really gonna bend that curve. As I said, calming down the pace of investment and then the revenue kicking in. That's particularly the case around the life and disability and, to a lesser degree, dental and vision. Why? Because these are more persistent businesses, particularly life and disability has much greater persistency than traditional voluntary.
We're hoping that gives us a knock-on effect of better persistency in the voluntary business, but that's what's really driving the bending of the curve. You will change the mix, a little bit higher benefit ratio, a little bit lower expense ratio over time. Obviously the goal is to drive better margins and so indeed dropping it to the bottom line.
Yeah, I think well said, Fred. Just to give a little bit more color to what Fred iterated, we see steady growth in our U.S. channel. That's the top line. You take a look at what we've been investing in. We've invested in new enrollment capabilities for our agents. Those investments are tapering off. We've invested in new platforms, administrative platforms for our group channel. Those investments are tapering off. The last thing Fred really highlighted was the investments in the Buy-to-Build. When you have those new entities coming in, we have invested in making sure we stabilize the systems that we bought over from, like, the Zurich acquisition. We put in new technology for our dental and vision platform. We expect to see those expenses begin to flatten out also.
We also have Steve Beaver, the CFO for the U.S. I'll just ask him if he has anything further to add.
No, Virgil, I think you got that right. Those investments in technology are gonna help us get the greater volumes through our platforms at those expense levels that Fred referred to that'll stay level as we proceed out.
Thanks. Michael Ward at Citi. I was just curious about the U.S. and sort of to what level you contemplate inorganic growth in the U.S. in terms of gaining share in certain lines or markets. You know, it seems like you're enjoying a healthy level of capital currently where some of your peers out there in the life industry, you know, are struggling. Could that present an opportunity?
Yeah. I'll talk a little bit about what you're seeing progress in. As Fred mentioned in his comments, and I mentioned in mine, we're seeing steady progress, and I'll talk about it through distribution channel with our career agency force. The progress you're seeing right now is our ability to get our veterans back active out in the market. They are continuing to focus more in that small market space. You're seeing recovery in the market now with small businesses, and that's what you're helping to see recover that channel. Now, we're not all the way back yet, so I would say the progress has been steady over the last few quarters. We continue to see, though, good progress for our relationships in the broker channel. We spent years beginning with acquisition of Continental American that we branded Aflac Group.
We've seen continued relationships grow there. We've performed over 20% growth this year within that broker channel space. I see more of the same going forward. We continue to talk about the Buy-to-Build, though. Very pleased with the progress we're seeing right now with the acquisitions we got from our life and disability products from Zurich, and we're seeing our field channel adopt the dental and vision products. So that's what you're seeing now. That's really our growth trajectory that you're seeing is a combination of those things. I like to say the sum of all parts. We've also rolled out a fascinating platform for direct to consumer. Now, there's been little growth there, but it provides a good opportunity in the future to go after those not currently at the work site.
I expect to see continued push there with our direct consumer products. When you put all the things together, that's what you'll see will be driving our growth going forward. I wanna make sure I understood. Is that what you're looking for? Yes, sir. Well, yeah, and I'll cap it off by saying this, one of the comments I made, earlier back in the third quarter was we're at 97% of pre-pandemic levels when you put everything together. I still expect us to surpass that going into Q4 and carrying forward into 2023.
All right. John?
Thank you very much for the opportunity. It's John Barnidge from Piper Sandler. Question for Fred. You talked about increasing your focus on Japan in 2023. One of the critical areas is reducing expenses through efficiencies. Is this new expense programs? Is it an extension of the paperless program, as an example? Or can you maybe elaborate on that a little bit? Thank you.
Yes, it's a combination of efficiency across technology advancement in general, and being able to reduce through attrition and natural turnover headcount, and also by moving to the cloud. Many of our platforms, we're able to sunset certain systems and that cost money and can reduce the expenses. Good old-fashioned expense reduction. What I commented on in my script was a larger contributor to expense reduction over time, and that is the movement to digitizing our platforms and particularly policyholder services. I know when you say digitize the platforms, that's really hard to interpret what exactly are you talking about when you say that as a company. Let me be very clear. There's really three things that drive paper in our system. Again, remember, we're talking about 15 million policyholders.
One is the applications that most of the applications are done on paper through the third-party agencies. Interestingly, some of our alliances like Japan Post and Dai-ichi have moved away from paper because both, Aflac and Dai-ichi and Aflac and Japan Post have a mutual desire to move to a digital environment. Applications are up in the 80 and 80%+ range digital, and the rest paper. Whereas when you move to some of the older agencies, that are smaller and less advanced on that type of technology, you're literally talking about single digits in applications digitized versus the vast majority in paper. You have to reduce that paper application. We have the technology. It's a matter of adopting the technology and rolling it out into these various agencies. The second area of paper is really just classic customer service.
Changing your data, changing your information often requires, in Japan, a form. That form, obviously being paper, is then processed in your policyholder services division. Still today, much of the customer change is not self-service. It's not going online and doing it yourself or doing it digitally. It is done through a paper form and often submitted and handled through your actual agent. Finally, claims. Right now, for example, about 30% of our claims are handled electronically or digitally. That contrasts to upwards of 80% in the U.S., for example. Still today, most of the claims require paper, not only paper from the policyholder and the agent, but also a paper form that comes from the medical provider to get your claim. That has to be reduced.
When you reduce those things and you look at, you know, three or four floors of policyholder services, people that are moving paper around, you gradually over time, and again, largely through attrition and managing headcount, the flow of in and out, you can bring that expense down. To me, more importantly, create a much better agent experience, a much better customer experience along the way. That is going to be a slow process of progress, but it's embedded in bringing our expenses down and holding our expense ratio down. This is not an Aflac thing. This is a financial service industry Japan thing. Don't think of it as somehow Aflac's behind the curve. This is exactly what's going on throughout the industry, and we're just trying to be in front of it and drive it as aggressively as we can.
Alex?
Just to follow up on the digitization that you just discussed. This is Alex Scott from Goldman Sachs, by the way. You know, I guess just with the new financial reporting under LDTI and the need to capture things, you know, at least going forward in a more robust way, do you feel comfortable with, you know, where you're at currently today before some of these initiatives take place, that you're gonna be able to consistently meet, you know, the expectations that seem to be much higher of that accounting? You know, does it make you question whether you should make a bigger spend to accelerate the digitization now, just given the transition?
On the LDTI, a couple comments I would make there. One is that, and again, I don't believe this is a uniquely Aflac thing, but what you would find is most companies that adopted, obviously, this is a GAAP provision and not an FSA or JGAAP and/or statutory issue. In adopting it was a large multi-year project that had significant costs associated with adopting the project, and those costs are largely behind us. Interestingly, what part of that cost was in fact making sure that your data lakes or your data systems were structured in such a way that you could grab very automated the information necessary to report properly. Also there was a level of what we called internally actuarial modernization.
In other words, LDTI gave companies an excuse to modernize or bring forward some of their models and some of their systems that they use to be more efficient. I think you're going to find that it's not a really tax on our expenses to adopt and operate under LDTI because there was large project expenses that went into it and are behind us, and now you're moving more to run rate.
In terms of the pace of investment in Japan, because of the way in which you manage headcount and because the rate of digital adoption is requiring third-party cooperation, not just your policyholder cooperating with adoption, but the agent that represents that policyholder, it gradually is going to take time for adoption, and you don't want your pace of investment to be too far, too high, too much higher than that pace of adoption. In other words, what we're trying to do is more pay as you go, continue to invest in the platform and advance the adoption so that we can recycle the improved earnings and cash flow and hold our margins where they're at in Japan despite transforming the enterprise. It actually is not pausing or delaying things. It's a recognition that it's going to take time to move to digital.
Be careful about a very large accelerated expense in the hopes of adoption and digitalization, because that's a risky endeavor for our capital. We're trying to manage that risk by going piecemeal at it.
Got it. That all makes sense. My second question was in the U.S., you spoke a lot about the things that are going on to grow the business. I was just interested if there's commentary you'd provide on just where persistency's been this year. I know some of those drivers are a little unique to 2022, but, you know, are there things you're doing to also come down where persistency's been?
I'll ask the U.S. team to take it.
Yeah. You've got that right. 2022's got a lot of pandemic impacts, particularly job quits. They were the highest in history, I think, in the first quarter. That's where we saw a lot of our lapses in 2022. As we go forward, we do expect persistency to stabilize naturally as we recover from the pandemic and the results of that. Some of the things we're doing are updating product design to drive persistency. We're looking at compensation to help drive persistency as well. Interestingly, we're also looking at administration of our products, portability, so when folks leave their company, they can take their product with them. So if we can drive that can help persistency. Some other things are just managing agent turnover.
When agents leave, or stop selling, they leave their accounts, you know. How do we reach out to those accounts, keep those accounts with Aflac or even drive, or improve penetration into those accounts? Then lastly, and Fred and Virgil's already hit on this, is Halo from our Buy-to-Build or our growth properties. You know, they tend to be stickier. We can get that cross-sell attached to those products. We see persistency improving as well.
Yeah. Just to add, the Halo that we had experienced in the third quarter, the dental product has a better persistency than normal voluntary products that we currently sell, and we achieved 0.78 or 78% of the dental products sold had a voluntary benefit, one of our original products alongside of it. We're gonna see more of that to come with our plans team. We are not pushing that strategy out as we develop the model further in 2023, but you can expect the same in the future for those additional products.
All right. Mark?
Good morning, Mark Dwelle with RBC Capital Markets. Just one other question, I guess, related to the U.S. sales approach. I mean, it would seem like in most cases you're attacking an incumbent in an existing worksite. What are the main kind of points of differentiation that you're using to get people to come over to Aflac as compared to an incumbent who inevitably has somewhat similar offerings?
Yeah. I'll first start, though. Our differentiator, though, is our field force. When you look across the market, the Aflac field force, right now we're carrying over 30,000 that are licensed to sell with Aflac from the career agency force. That's a differentiator, especially in that small market space. It's also a differentiator in the broker space also. 'Cause about 50% of the time when you see a broker sale, one of our agents is either in there already or working with them as part of fulfillment. That is a unique differentiator is just our distribution channel itself. When we're going into the market also, think about what I kind of shared earlier when I was speaking.
One of the key things we talk about first is our advertising. We are amongst the top out there really just educating the consumer on what supplemental products mean. The entire thing you see around Close the Gap is intentional to let people know that we provide the type of insurances that medical expenses generally do not cover. It's our education. When people see our brand, they know the brand. We will walk in. Automatically, we're able to get appointments, we're able to get opportunities just because of the strength of the brand itself. Other things we're doing out in the community, some of the people we call Champions of Care that we've aligned ourselves with, like Nick Saban, Coach Deion Sanders, Coach Prime, those opportunities help expand the reach that we haven't had in the past. We advertise differently now.
We're not just on TV. We're on social media. We're taking advantage of every channel out there. I will say, though, in that small market space, when we have our agents go in, continue to push all products, our differentiator is the brand. When you go up market into the broker space, one of the things that we did was with the acquisition of Zurich, that gets us, and you've heard us talk about this on the front page of the invoice now, with our dental and vision products, along with our life and our absence management, those are differentiators. We are now winning cases in that jumbo case space. Where a lot of people did not see our brand in that larger and jumbo case market, we've had success.
One of the things I'm most proud of this year is the cases that we won with our Premier Life, Absence and Disability Solutions we acquired. That was new business. It was not crossing into existing business. What we put on the books this year was really new relationships. I think that we'll see more of the same as we grow those by the builds Steve mentioned. We'll continue to cross-sell and have that halo effect, but our brand is one of the key differentiators that help us win in the cases.
When you go into, I'll just add a couple things. On life and disability, obviously, you've got some very large incumbents, where their earned premium in place is in the multi-billion category. What we're finding is that there's a real advantage to having acquired a four-year-old greenfielded platform with a group of executives with 20 and 30 years of experience in the industry that from scratch, together with Salesforce, developed a systems platform to manage not just the life and disability, that's not the hard part. The hard part is the leave management, absence management, and all of those administrative bells and whistles. Because they did it from scratch, they built it when leave management started to become the differentiator in a finalist presentation, it is a really impressive platform.
The advantage that gives you over the incumbents is the incumbents are often dealing with, and we know this from our other businesses, legacy platforms that can be difficult to maneuver, or they're changing platforms which can be disruptive to consumers, or they are integrating acquired platforms, which has been going on in the industry, and that can be disruptive. By buying the Zurich business and most importantly, leaving it alone to stay on the path that they were on when they built the business from scratch, we've been able to be awarded business and really are viewed as an impressive player. I think the only reservation is actually what you're saying. People have to kind of watch and say, "Hey, it's easier to go with the larger scale incumbent that I feel safe around.
I need to understand that I can be comfortable going with you, Aflac, who's trying to forge new ground." On the dental and vision side, I don't know that there's anything particularly special that we bring to the table with the exception of exactly what Virgil said. That is when you get into employers who have less than 100 employees, you actually are running into quite a few small businesses that purely do not offer dental and vision. It is true blue ocean. They don't offer the benefit, and so you are, for the first time, introducing how the network, dental and vision product can work.
In cases of replacing somebody that's an incumbent, like the major players, like a Delta Dental and so forth, you typically need some sort of disruption, some sort of something that has gone on with the service model or some reason to move because we're not pricing more aggressively. What I do think will become an advantage over time is our network. Right now we've got about 22,000 dental offices in our network. That's up from 5,000 when we acquired it. As many of you know, you're needing to have something in the neighborhood of 80,000-100,000 nationwide. We lease networks to make up for that. Over time, the way in which you manage these networks is really your competitive advantage.
What we're finding is some of the big players have such large networks that that's impressive, but also difficult to manage when you get larger. Those larger networks can be more, more variable in the service levels, so you wanna find that sweet spot. We're trying to design it the right way from scratch. Obviously, when you walk into a dental office anywhere in the United States and you say you're Aflac, you typically get a dental office that is interested in joining your network because of our name and our brand, as Virgil says.
Just one other small follow-up is, you've added the dental and the vision. Are there any other products that you feel like you need to add to the suite, to continue building your competitiveness?
I think really what I would tell you is it's more the frequency of upgrades. We have to have a service model, a platform of new product innovation and development that is more, that is faster cycle of refreshing product. It's less about a new product and more about adding to the product. For example, adding things like mental illness type coverage to disability products, COVID and infectious disease type additions that came out of the pandemic. It's more refreshing the existing chassis that you have than new products to enter. I think with our Buy-to-Builds, we now have a good product suite and aren't really in need of doing more. What you will see is us finding ways to participate in less core products.
For example, pet insurance, where we have a branded product to open the door to create the conversation to fill that need, but it's not one that we effectively collect premium and generate a pre-tax profit margin on. You'll see us look at those types of ancillary page two products that are making their way towards page one. Pet insurance has been a voluntary page two product, but it's gradually moving up the scale to being closer and closer to a core benefit. When we see that happening, you should expect us to find ways to participate but still realize we're not in that business.
Just to add to what Fred said, when Fred described that we're gonna continue to be innovative with our products that we have, we think we've got the right mix out here. It's also, again, making sure that we can have those products distributed easily out there. Again, I will highlight that our distribution is a key core differentiator. The ability to have the Aflac Nation, the army of veteran agents out there that can push the product but work in, you know, full collaboration with the broker channel, having the two channels work together and then now expanded those offerings through the new digital platform that we're calling direct-to-consumer. We've made it available anywhere, however you wanna purchase.
You wanna purchase online, you wanna be assisted by an agent, or you wanna come through one of the broker relationships we have. We've made it easy to make our products available to the consumers out there.
I wanna make one question as we're wrapping this up. I think you can see what I'd said earlier in my talk was that we've got smart people doing a good job and can answer all the questions. The one thing I wanna just make sure is clear here about the U.S. is the evolution of our sales organization. If you look back 10 years ago, you wouldn't recognize it because it was a sales force of just agents predominantly writing under 100 people. Sometimes we would write cities, counties, boards of education, and state governments. Other than that, we wrote very few big accounts, but we would write a few every once in a while. As we've expanded, we've put together the Hatfields and McCoys in that there was quite a bit of issues between brokers and our agents.
We've worked through that in a way to where they work together now instead of at each other in a way that I think is very positive. Our agents are actually selling for our brokers. It's also a shift in the business model in regard to product. You've moved from individual policies that they can take with them very easily upon retirement. For example, if you took the cancer business when they leave the account, about only 95% of our business is written direct or through where you'd own the individual policy. But yet the in-force business is closer to 40%. A lot of people are keeping it. When we move to broker, they want it to be sold on a group chassis, predominantly because they're located in different states.
You don't do as much enrollment with the associates in the bigger. It's done through the intranet. When possible, they're now letting us bring our agents in to explain it better. This is all part of a process. We get to see much bigger accounts, and we're enrolling much bigger accounts, and if you broke it apart, you'd see how good that looks. At the same time, it's cheaper, so you gotta write more volume because people tend to drop it after they retire. That's when a lot of your claims take place. But to meet the needs of what the consumer, which includes the brokers want, that's what these products are, and so they have lapse issues too. At the same time, they can be very persistent depending on the account and what we do.
It's an evolving situation. All in all, when you look at the total, we're seeing a return of our agents, which is very good because they, you know, they stayed inside like everybody else. And what hurt us during COVID was the young ones, in terms of tenure with the company, left us. They weren't making a living, 'cause they couldn't call on people. We've had to go back and recruit these people and get back started. I think our U.S. is doing a great job in that respect of coming back, and the sales will ultimately tell the results, and then as we work on persistency and what's taking place there. Just kind of a brief review to make sure we're all on the same page of how it's doing and what's going on.
Thank you, Dan. I think that's a good point to conclude our first Q&A panel. I just wanna thank all the panelists here on stage, as well as my colleagues in Tokyo for joining us, late in their evening. I'll give a moment for our panelists to exit stage left or right, whichever they'd like.
Why don't you guys go first?
At this time, we'll begin our final presentations. First, we will have an overview of our investments and investment strategy from Eric Kirsch, Global Chief Investment Officer, and Brad Dyslin, incoming President of Aflac Global Investments. Max Brodén, Deputy CFO, will then conclude our presentations with a focus on our financials and outlook. We will then conclude with our final Q&A panel. Now we will hear from Eric Kirsch. Eric joined Aflac in 2011 as first Senior Vice President and Global Chief Investment Officer. He was promoted to Executive Vice President in 2012, and in 2018, was named President of Aflac Global Investments.
Over his tenure, he has been recognized by Chief Investment Officer magazine as a top 100 power player in investment management, and I've had the pleasure of working with Eric since day one and now have the pleasure of introducing him to you today. Ladies and gentlemen, Eric Kirsch. Eric?
Good morning. As you know, I will be retiring from Aflac effective March of next year. I am privileged to have had the opportunity to join this great company and create Aflac Global Investments. Over 11 years ago, Dan tasked me with building a world-class investment team. From the early days in 2011, we have certainly come a long way. Today, we have over 143 staff split between New York and Tokyo offices, managing over $100 billion in assets. We have high-performing, globally integrated front office teams with portfolio managers, traders, and credit analysts supporting both internally and externally managed asset classes. We have greatly enhanced our middle and back offices and added important support functions such as legal, compliance, human resources, and technology. We have evolved significant investment strategies, starting with our strategic asset allocation process.
The SAA serves as the backbone of our investment portfolio management, capturing Aflac's enterprise risk appetite and capital objectives. We have made great progress improving the portfolio's diversification by adding new asset classes, including alternatives and expanding into different forms of private credit. We introduced sophisticated interest rate and currency hedging strategies and implemented a fully integrated risk management process. We have positioned the platform to be a significant investor in private markets, both through internal specialists and strategic asset manager partnerships. I assure you, having experienced multiple market events, including the Fed-induced taper tantrum, negative interest rates in Japan, and most recently, the pandemic, this is a resilient platform with world-class talent that has delivered excellent investment results. Brad was the fourth employee of Global Investments and has been part of our senior leadership since that first day.
Having worked side by side for over a decade, I know Brad is the right successor and leader for Global Investments. I have no doubt the next several years will be full of challenges. I have every confidence that Brad will lead the team with great success. Now let me hand it to Brad to update you on our portfolio and strategies.
Thank you, Eric and good morning. Let me start by taking a moment to personally thank Eric for his leadership, dedication, and vision, which laid the foundation of Aflac Global Investments. I am proud to have been his first front office hire and owe him a tremendous thank you for the opportunities, mentorship, and leadership he has provided all for over a decade. I am honored and humbled to assume the leadership role of such a tremendous organization of talented professionals. Now let's talk about this past year. 2022 has been a year of incredible volatility across financial markets. The Fed's interest rate hikes have had a profound impact across investment markets as investors digest the impact of inflation at the highest level in 40 years. Our disciplined approach to credit underwriting, portfolio construction, asset allocation, and currency management have positioned Aflac well for this environment.
Our strategic asset allocation process serves as the North Star of our portfolio management activity and is rooted in long-term performance expectations to meet our objectives for capital, risk, and liquidity. This process allows us to deliver attractive risk-adjusted returns regardless of the macro environment while maintaining high standards for quality and diversification. In 2022, this disciplined approach allowed us to capture opportunities in yen credit and U.S. dollar private credit while continuing our systematic allocation to a growing alternatives portfolio. As a result of higher rates and wider credit spreads, the book yield of our consolidated portfolio increased 38 basis points over the last year. We have a high-quality credit portfolio with 93% of our holdings rated investment grade and an average credit rating of single A -.
Our private loan holdings, which I will discuss in more detail in a moment, benefit from a broadly diversified portfolio with only first lien senior secured positions. Credit investors have enjoyed a benign environment the last several years, leading to low defaults and credit losses across the industry. With the prospects of a global recession increasing, so is the probability of a turn in the credit cycle. We believe our portfolio will perform well in the face of this economic uncertainty with any losses we may incur being well below peers. Through the third quarter, we deployed approximately $6.8 billion with an average credit rating of BBB. Our activity to date is focused on U.S. dollar private credit, with 70% of our investable cash flow going into both fixed and floating rate instruments.
The higher rate environment, plus the higher spreads on private assets compared to U.S. dollar public bonds, allowed us to invest at new money yields that exceeded the yield on assets leaving the portfolio, having a positive impact on overall net investment income. Led by our Aflac Japan investment team, we took advantage of attractive opportunities to swap over $800 million of JGBs into higher yielding yen credit assets, picking up on average 40 basis points, which is especially noteworthy in context of the continued low rates in Japan. Our loan portfolio remains an important part of our strategy. It has grown to $13.1 billion. Naturally, the $11.3 billion, which is held in floating rate assets, has benefited from the increase in short-term interest rates.
The market's forward expectations for short-term rates has presented us an opportunity to secure a portion of these higher rates, which I will also touch on in a moment. Most of our real estate holdings are in transitional real estate loans, although we also have exposure to more traditional fixed rate, longer maturity commercial mortgages. Recall that transitional real estate is an investment-grade quality form of bridge financing to allow the property's owner to reposition the asset. In addition to ensuring you have a high-quality property, underwriting the transition plans and the sponsor are critical. We believe our diversified portfolio of first lien loans with appropriate leverage will perform well through the cycle. Our middle market loan portfolio has many of these same core fundamental characteristics, broad diversification, only first lien senior secured positions, and modestly leveraged companies backed by supportive sponsors.
Although we generally avoid some of the more cyclical sectors, we will undoubtedly see pressure on some of these smaller companies during an economic downturn. Working closely with our outside managers for these loan assets, we have stressed the portfolio to capture both a higher cost of capital from floating rates, but the potential pressure on earnings. While we would see losses under our most stressed scenarios, we believe they are manageable. Our conservative approach further boosts our confidence in the overall risk and return characteristics of this important asset class. We continue our systematic and disciplined approach to building our alternatives portfolio, increasing our total commitments to $3.7 billion. We ended the quarter with $1.6 billion of paid-in capital, an increase of 20% over last year. Our strategy focuses on private equity, supplemented with modest exposure to real estate equity.
Our portfolio is very well diversified, especially when looking through to the nearly 3,300 underlying primary assets. In what has been a difficult period for equity returns, our portfolio has delivered positive year-to-date income of $125 million, driven by strong performance earlier in the year. We do expect variable net investment income to be challenged the next couple quarters as private equity valuations track the drawdown of public equity markets. Despite the current volatility and negative returns of the public markets, we believe our approach to building this portfolio will generate attractive long-term returns at or above the 10% rate we use in our internal planning. We plan to continue growing our allocation towards our strategic asset allocation target of 3%-4%.
As touched on earlier, in response to the 375 basis points of Fed rate hikes and expectations for more to come, the forward market for short-term rates has risen substantially. Throughout the year, we took action to reduce our risk of lower floating rate income should interest rates reverse course as the U.S. economy slows down in response to this new interest rate regime. We executed interest rate swaps covering about 70% of the floating rate portfolio, protecting approximately $700 million of our income that would be at risk from lower rates over the next five years. The remaining 30% of our portfolio will continue to float and reflect the current market for short-term interest rates, allowing this portion to benefit if rates do rise further. Additionally, the enterprise has exposure to short-term rates in a large unhedged liquidity position at the holding company.
This balanced approach reduces our exposure to what is likely to continue being a volatile interest rate environment. A point emphasized last week when the lower than expected inflation number drove rates lower by about 25 basis points. Aflac Japan currently holds $28 billion of U.S. dollar-denominated assets, including both fixed and floating rate instruments. We currently hedge $4 billion of the floating rate book with short-term currency forwards, effectively converting these securities into yen assets. With the increase in short rates, the cost of these forwards has increased significantly. Because we implement an offsetting trade at the holding company, we recoup these costs on a consolidated basis. The remaining $24 billion is unhedged, creating an economic link to the U.S. dollar, which reduces our enterprise exposure to movements in the yen.
We purchased put options on $14 billion of this unhedged total, which provides cost-effective tail risk capital protection against the weakening dollar. This strategy is recalibrated annually to reflect market conditions and considering our capital position. Max will provide more detail on our overall enterprise approach to managing currency exposure. Over the last several years, the global investments team has implemented a disciplined approach to building and managing a high quality, diversified portfolio and made risk management a critical component of our cultural fabric. This core approach of fundamental underwriting focused on downside protection positions us well as we enter this period of extreme economic uncertainty. We did not wait to see storm clouds to build an all-weather portfolio. The market volatility from this uncertainty also brings opportunity. We are proactively managing our currency exposures and capturing opportunities from higher rates.
We will pursue those opportunities that meet our standards for both risk and return in context of the current investment environment, and maintain our systematic approach to building a strong alternatives portfolio. In closing, I would like to reiterate, I am honored to be the next president of Aflac Global Investments and Aflac Global Chief Investment Officer. Over the past decade, we have assembled a team of talented professionals in New York and Japan. Their exceptional skills and inspiring commitment have made lasting contributions to Aflac. Working together with this amazing team, with the tremendous support of our executive leadership and board of directors, I know Global Investments will continue to execute at a high level and deliver on our promise to stakeholders. Thank you. I'll now turn it over to Max.
Thank you for joining us. I'd like to start by giving you a few comments on U.S. GAAP accounting changes. First, long duration targeted improvements or LDTI is the most profound accounting change for the U.S. insurance industry in over 40 years. It goes into effect on January 1st, 2023. LDTI will have no impact to the FSA or statutory earnings, cash flows, capital, dividend capacity, existing debt covenants, or how we manage the capital and the company overall. However, it will have a significant impact on Aflac's accumulated other comprehensive income, AOCI. As a result of our unique business model, especially as it relates to our very profitable Japanese business.
As of June 30, 2022, we estimate the negative noneconomic impact on AOCI have reduced by 2/3 from the $18.6 billion previously disclosed upon adoption, which gives a total equity of $19-$20 billion as of June 30th, 2022. Of note, this impact has reduced materially since the early days of our disclosures and since transition, given the rise in interest rates in both the U.S. and Japan. When incorporating recent unlocks and updating the future net premium ratio, we would expect benefit ratios to be slightly lower under LDTI. Expense ratios are expected to be modestly lower, as DAC will be amortized over a longer time period. Pre-tax margins are therefore expected to be modestly higher as a function of the benefit and expense ratios in both operating segments.
In conjunction with the adoption of the updated standard effective January 1st, 2023, the company will change its practice from recording the change in the deferred profit liability on products with limited payment features in the benefits and claims line to recording them in the net earned premiums line in the consolidated statement of earnings. This reclassification will have no impact to net earnings, but will reduce earned premium by JPY 24.5 billion, essentially rebasing our earned premium lower by roughly 200 basis points. This is simply geography, but will better reflect the growth trends in earned premium going forward. In Japan, as we exit the pandemic and settle into the new LDTI regime, I would expect our well-priced in-force to show greater stability in terms of benefit ratio, excluding unlockings, and to be slightly lower than what we projected in previous years.
This is a function of both favorable morbidity experience and improved mix of business. Going forward, we would expect to operate in the 66%-68% range. With a negative revenue environment, we are actively reducing our expenses. In order to keep our expense ratio flat, this is an ever-increasingly challenging task, including both tactical efforts as well as more long-term transformational initiatives. We would expect our expense ratio to be in the range of 20%-22% going forward. The strength of the U.S. dollar versus the yen has increased the proportion of net investment income as a component of our pre-tax profit, as we hold slightly less than 30% of our investment portfolio in U.S. dollar denominated assets. With a greater contribution to profitability from NII in yen terms, our pre-tax margin is naturally pushed up.
This, together with a lower expected benefit ratio, leads us to an expected pre-tax profit margin of 26%-28% going forward. Underlying earned premium for 2023 and 2024, when adjusting for the DPL reclassification and internal reinsurance, is expected to be in the range of -1.5% to -2.5%. In the U.S., as we are migrating from an invest-and-build mode to slowly begin to reap benefits of the foundation laid over the last couple of years. Don't get me wrong, there's still a lot of work to be done, but the foundation for growth has been laid. There are many moving parts and significant mix shifts impacting our financials as Group Life and Disability, Network Dental and Vision, as well as direct-to-consumer products become a greater proportion of our in-force.
For the most part, these products carry a higher benefit ratio and lower expense ratio, so you should expect this impact to impact our ratios over time. Near term, we would expect to operate with a benefit ratio in the range of 47%-50% and an expense ratio of 37%-40%. This translates into an expected profit margin of 17%-20%. Capital in Japan have, despite significant rates and FX volatility, remained quite stable, both on an SMR and ESR basis. Strong capital ratios with a broad capital toolkit helps us manage through potential stresses to continue uninterrupted dividend flows from Japan to the holding company, something we value highly. Each day, we get a little bit closer to 2025 and a full adoption of ESR.
Already today, ESR is a key ratio for us as we make financial decisions to manage the business. We would expect the implementation of ESR to lead to greater stability in our reported capital ratio, as ESR is a more economic capital regime and give opportunities to manage capital in a more efficient manner. I would note that our planned internal reinsurance transaction, which I will address in a moment, is expected to marginally lower capital market sensitivity of both our ESR and SMR, mainly by reducing sensitivity to dollar rates and credit spreads. We expect to end the year with a combined risk-based capital ratio of approximately 670% in Aflac U.S.
When we stress test capital levels of our U.S. entities and evaluate the risks of both the assets and liabilities, as well as compare ourselves to peers, we intend to target an RBC closer to 400% over time, given the strength of the earnings profile, low risk and stability of our operations, and low asset leverage. FSA earnings will be significantly boosted in 2023 by the upcoming internal reinsurance transaction, as a policy reserve will be released by Aflac Japan. The underlying trajectory of FSA earnings remains intact with an upward sloping trend driven by very strong in-force profitability, which we expect to continue. The weakening yen has boosted our FSA earnings as we hold a significant portion of our investment portfolio in U.S. dollars, predict-