First, I'd like to welcome Fred Crawford, COO of Aflac, and Max Broden, CFO of Aflac. Thanks very much for being with us today. To kick it off, I wanted to ask a little bit more of a high-level question for you. I thought we could start with a general update of the strategy that you outlined at your investor day. Could you run us through your strategic focus that you outlined there in Japan and the U.S. for spurring more sales growth?
Sure. Can you hear me? Great. Look, I think one of the underlying themes of our investor conference a few weeks ago here in New York was that there are a lot of things that are very well positioned. Capital, cash flow generation, core margins in the company are all very strong. Earnings and earnings performance has been very strong, and it's been quite resilient through COVID. We expect to remain resilient in current conditions related to inflation and recessionary dynamics. However, what we have been very focused on in recent years is growth. That is where we have seen weakness. Certainly, some of it brought on by COVID and the face-to-face dynamics of our sales model in the U.S. and Japan, but not just COVID.
There are investments that we have needed to make and changes in our business model to set the stage for better growth or another leg of growth going forward. We spent a lot of time on Japan and U.S. on what types of investments are those. In Japan, I would very simply say this. We are expanding our third sector, which is basically supplemental health portfolio in Japan to attract new customers and approach new demographics, mainly younger demographic, and carry that customer relationship through their life cycle. For example, introducing a disability product naturally attracts a younger working generation in Japan. The renewal of our approach to small denominated life insurance and savings related products tends to be popular with younger generation.
One of the products being child endowment, for example, where within a whole life policy, you effectively put deposits in there to save to then pay for your child who reaches college age in Japan. Bringing that younger generation in through disability products and renewed savings products is part of the strategy. We carry them through the life cycle. By then, as you age, you naturally become more a candidate for medical insurance and medical coverage as you become a working individual, married, family, et cetera. Later in life, our cancer business becomes very popular because cancer is still a disease of age. Although you will find younger generations inflicted with cancer in Japan, it is still a disease of age.
We introduced elderly care products, which are supplemental elderly care products, not to be confused with long-term care that we're used to in the U.S. This is a different type of product that has a very different, in fact, lower risk profile than you would expect. It's carry that customer through the life cycle and refreshing that product on a more continuous basis. Obviously our two big products in Japan are cancer and medical, and we have refreshed our cancer product this year. We expect to introduce that product into Japan Post this coming year, which is one of our largest distributors of cancer insurance in Japan. We are refreshing our medical product later in the year. A fast refreshment cycle as well as expanding through the life cycle.
You go to the U.S. that growth strategy is really an outright build strategy and buy-to-build strategy where we have acquired and entered into the group life and disability business as well as the network dental and vision business. Why? We're moving into those businesses because if we can offer what's called first page benefits, meaning benefits that you are interested in on the first page of your enrollment experience when you enroll each year for your benefits, that will naturally attract a higher penetration rate inside the company. More employees within the company like the first page benefits, in part because your employer is often subsidizing those benefits. Why wouldn't you sign up for them?
If it can be offered alongside our voluntary product, we'll see halo effect we call it, where we sell more of our voluntary product as a halo impact of offering dental and vision through group life and disability. It's not just the growth of those acquired platforms, but it's that halo effect or benefit of increased sale of our core voluntary alongside those new lines of business. We launched direct-to-consumer business. For many years, people have said, "You have such an amazing brand. I'm surprised you don't go direct-to-consumer." The answer has always been actuarial, and that is adverse selection. Imagine for a moment the individual who wakes up in the morning and goes shopping online for supplemental health insurance, critical illness insurance, accident, cancer, et cetera. Right?
Actuarially, you have to be very careful and understand that's likely to be the case. You need to structure your product and target your market in such a way to get a broad and diverse A set of individuals so that you can actuarially meet the loss ratio expectations that are priced into the product. We now have that sorted through and figured out, and it's really important to have a direct-to-consumer model now. Why? Because the gig economy is the fastest-growing part of the labor force in the U.S., and they don't have a traditional payroll deduction W-2 relationship with their employer. We must get to them through the phone and direct, and that's why we built that program. Those are our core.
In a quick statement, those are our core growth aspects, but it's addition by subtraction, meaning we're focused on growth because quite candidly, every other aspect of our financial model in growth and value model is actually performing very well and through the pandemic. It's all about growth.
Maybe just drilling into the Japan Post that you mentioned as part of that response. That's been a bit of a recovery story over the last year or so. How do you expect the new product launches that you mentioned, as well as more face-to-face interaction as the pandemic hopefully subsides here in Japan? How do those factors drive that sales growth back towards the historical levels that you got there?
Sure. Now, first, what I would say is COVID in Japan has played out much different than it has here in the U.S. They're now on their seventh wave of various strains of COVID running through the system, the strains of COVID that you're all accustomed to and have read about. The nature of the society in Japan is that when there are these waves of COVID, you will see pieces of the economy shut down and close up. Once upon a time, it was through emergency orders and actually government regulation and government pressure to shut down. More recently, the government's doing the opposite in trying to encourage businesses and consumers to open up despite the COVID environment because the severity level in hospitalization has been quite low, everything we've experienced in the U.S.
Japanese society is not opening up during periods of COVID for the same reasons they wear a mask during cold and flu season. They wear a mask and they avoid contact and density, if you will, or experiences that give rise to density during COVID. That is impacting not just the sales, but also Japan Post. Think about it, traffic through a post office and face-to-face meetings out of the Japan Post Insurance agents who we sell through are all down. What people often miss is that when you have a large wave through Japan, it's not just a matter of an inability to schedule a face-to-face meeting. By the way, you should know, in Japan, that is the way sales are done. There really isn't a robust digital sales environment in Japan. It is face-to-face.
It's often two meetings, not just one meeting before a sale is made. It's not just the face-to-face meetings. You quite literally have thousands of agents who have come down with COVID and are unable to actually go out in the marketplace and work and make sales. Japan Post, like everybody else, given the size of their army, right now, we sell through 20,000 post offices in Japan and 10,000 agents at Japan Post Insurance. If those numbers are down due to COVID and the traffic is down, that has an impact. They need to recover from COVID. Beyond that, Japan Post obviously went through some well-recognized compliance issues. They were quite literally shut down for a period of time by the FSA. You shut down a sales model, getting that rev back up again from zero is very difficult.
It's not just that Japan Post was down. They went down to near zero sales because of regulatory restrictions. It has been slow to build back. Each month, we're seeing increased proposal activity. Each month, we're seeing increased sales. When we launch the new cancer product in their system in the second quarter, history has suggested that there's a lot of excitement and a lot of activity around that. In fact, the last time at the peak sales we ever did through Japan Post Insurance was deep in the relationship when we refreshed the cancer product. We would expect a similar reaction this time around, albeit not at the levels pre-COVID because of what I mentioned earlier.
Sales can be quite volatile, and you've seen it over the last couple of years. Net premium continues to be very stable because of the very high consistency we have in the Japanese business. When we move into and going forward, we would expect that to be -1.5% to -2.5% on an underlying run rate basis going forward. In 2023, there is some important changes that are taking place. One is accounting-related. We have the installation of LDTI starting on January 1st. With that, we're going to elect to do one accounting change, and that is how we account for deferred profit liability, which historically we have run through the benefits line, but we are now going to reflect that up in the earned premium line instead. This is really to, in a much better way, reflect the growth rate of the underlying business.
The essence of this is that it will rebase our earned premium in Japan in that segment and will rebase downwards by 200 basis points. We are also on January 1st going to execute a reinsurance transaction where we will cede two blocks of business from Aflac Japan to Aflac Bermuda. What that means is that from an accounting standpoint, that will lower the net earned premiums recognized in the Japan segment, but they will then occur in the corporate and other segment. This will lower net earned premium in Japan by about 300 basis points, but that's also sort of a rebasing of the net earned premium. From this new base, we would expect to, going forward, have a growth rate of -1.5% to 2.5% in Japan.
That's all really helpful. Maybe shifting to the U.S. business for a moment. Could you talk about the performance you're seeing headed into the end of the year through the open enrollment process, just in terms of take-up rates, and we consider maybe inflationary pressure on some of the consumers and whether you're seeing that versus more face-to-face in your distribution force really being able to get back out there in a bigger way this year?
Unlike Japan, I would say conditions in the U.S. have, in fact, improved considerably. In fact, the notion of a COVID-related impact to your sales model is really not in existence anymore. I would say the only implications of the COVID environment to our sales model in the U.S. right now is actually a continuation of remote working that accelerated during COVID. What I mean by that is, remember, we have agents in the small business category that are going into a business and meeting face-to-face with the employees. If more and more of those employees are working remote, the only way to get at them is through more electronic enrollment. With medium-sized companies and larger companies, that's always been the case. Everybody is electronic enrollment, very little in the way of face-to-face, and so there's no real impact to that business.
The group business, the broker-driven larger and mid-sized company business continues to march along, and that is the fastest-growing part of our business, and we continue to see that momentum. You have a little more of a backlog dynamic that you can track in those businesses where you know a little bit earlier how things are coming together. Same with GLAD. We know already that we are heading towards a continued level of growth rate and good growth rate, in the group business. The small business individual sector is the one where it's a little bit more difficult to predict. You don't have that backlog type dynamic, and that's the one that's most impacted by things like face-to-face COVID remote working conditions. What we are focused on there is recruiting.
Recruiting has been weak in that small business agent category, we're now working hard to create incentives and embed incentives to drive as much recruiting as we do outright sales. We would expect that model to come back. You typically have weak recruiting atmosphere during periods of strong employment. This is one of the things that makes our business model very defensive in nature heading into a recession. Usually in times of recession, you don't have much impact on morbidity margins for obvious reasons, and that's the biggest part of our profitability. What happens is in lower employment levels, even though there are less employees to see, identify, and sell, you end up with a lot more agents because you can recruit much better to a commission-only job in a period of weak employment.
There's so much blue ocean opportunity in what we do, meaning very low penetration rates in the U.S., that the more feet you have on the street to interface with more small businesses, the more sales will grow. We tend to have a resilient model, even a growth model, during periods of recession. The key to our growth model in the U.S. is delivering on our buy-to-build acquisitions, delivering on the halo effect, continuing the momentum in the brokerage business, which we expect to be strong. Bringing back to life through recruiting and development our core agent platform, which includes 30,000 licensed agents across the U.S. It's a big engine, and when it's weaker, bringing that back is ultimately going to be an underpinning to recovery and sales in the U.S. We're projecting a good recovery.
We expect to get back to about $1.8 billion in sales, which would be a peak level of sales in our company's history, by 2025, and we expect to add incrementally a considerable amount of earned premium or revenue over that timeframe, incrementally upwards of $1 billion of earned premium incrementally through those buy-to-build platforms and related halo effect. We definitely are on a growth path in the U.S., and at the end of the day, we have a mature model in Japan. That's the math of it. At the end of the mature model that's been priced properly and run properly, it throws off a considerable amount of cash flow each and every year.
Portions of that cash flow are being redeployed into where we see more blue ocean, more low penetration, higher opportunity, and that's in the U.S. market, and that's what we've been doing over the last few years.
One of the key disclosures you all made at the recent Investor Day was around the Bermuda reinsurance structure that Max, you touched on briefly. I thought maybe we could just come back to that for a minute. Can you discuss some of the advantages that it'll provide you both on the existing book of business as well as new product development?
Yeah. There's really two reasons why we're doing this. The first one is really for us to be able to manage risk better around the group, obviously release and redeploy capital in a more efficient manner. What we're doing is when we cede blocks of business from predominantly Japan to Bermuda, what you will find is that these blocks of business are very capital intensive. That is because of the very stringent reserve requirements that exist in Japan today. Over time, what that will do when we can hold it at a more economic basis, which we can in Bermuda, that obviously frees up capital. The other element to it is more of an offensive strategy, in Japan we've seen over time that more and more competitors have moved into our space, they also become more price competitive as well.
What it gives us, this platform, is an opportunity to be a little bit more aggressive in terms of the pricing, because if we can utilize reinsurance, we can still generate very strong IRRs and very good returns on the business that we write. At the same time, we can share some of those economics with consumers going forward. This is especially important as you look at our medical business, where we have been losing market share for quite some time. Also as we then look to become a little bit more competitive in the third sector space as well.
Maybe sticking on capital for a minute. One of the things that's evident as we look through your business is that the capital levels are very strong. You operate with higher RBC ratios than most companies in the U.S., and I think you probably have higher ESR in Japan than most other companies as well. When I think through those capital levels, and that's even separate from considering the Bermuda reinsurance that you just discussed. How much flexibility does that provide you? How will you potentially look to redeploy that, and could you get a little more aggressive over time than maybe you've been over the past handful of years?
Yeah. We hold a lot of capital. We generate a lot of capital, the reinsurance platform gives us even more capital, which in other words, is saying that the CFO is not doing his or her job. Which we can debate. The fact of the matter is, we've been traveling with high levels of capital for a good reason. We're a supplemental health insurance company, we've been going through a global pandemic. That's one of the largest tail risks that we have from an operating basis as a company. That made a lot of sense to actually travel with a lot of capital. Now we're facing a potential recession, I feel very good about going into a recession with high levels of capital. That being said, this is not the kind of level where we would like to operate long term.
We've been explicit in the U.S. saying that over time, we would expect to run at a 400% RBC ratio. In Japan, we continue to hold very strong levels of capital, as we mentioned, both on an SMR and ESR basis. During this, we also generate strong levels of capital of $2.6 billion-$3 billion of underlying capital generation each year. All of this obviously is only good if we can deploy it and deploy it at good returns on capital. Otherwise, it doesn't do much for us. We obviously continue to increase the dividend. We have also bought back quite a lot of stock in recent years, and I would expect these to continue. On the M&A front, we have broadened our strategic positioning, especially in the U.S., with a few smaller acquisitions. That is something that we potentially could continue to do.
It gives us flexibility to execute the strategic agenda. Over time, I think that we have essentially laid out the growth platform right now, and I would expect that going forward, capital deployed will be through writing new business and accelerate the growth rate. The new business stream should help us get those capital levels down, if you want to call it that way. Also, the vast majority will come back to shareholders, through dividends, buybacks, and I think that our recent past is a pretty good predictor of what we will do going forward.
You try to be balanced, and the company has always held that philosophy, balanced in the way we deploy the capital. In recent years, we've invested about $575 million in buy-to-build platforms. We've invested another $500 million in what we would call opportunistic investments, in alliance partners, and/or venture capital investments. Meanwhile, we're buying back stock at a clip of at or north of $500 million a quarter. Keep in mind, we increased the dividend 20% two consecutive years in a row into a pandemic. That's a lot to say for a company that's now 40 years of an increased dividend track record. We try to look at this balancing act of first maintain robust and healthy ratios with strong ratings and good relationships with the regulators who often act as gatekeepers to that free cash flow that's developed and released.
Invest into your company, but invest for good returns, and we see the good returns being in the U.S., and opportunity. Keep that dividend track record, and when the capital is in excess above that, buy back your favorite security. For us, we buy our stock back because we believe in the economic value growth and strategies that we've put together. That's really our philosophy. We don't put our eggs in any one basket. We try to be diverse and balanced in what we do. That particularly is nice heading into a recession, where having those good capital ratios, even after all that buyback and dividend, is a good place to be.
That's helpful. Next one I had for you is on cancer screenings, and it's a little bit of a blind spot for us as we sit here and think through reopening. I think the U.S. has normalized a bit more, but in Japan, I think medical utilization still seems somewhat depressed. What's your perspective on that? You see a lot more of the numbers than I do, so I'd just be interested in your perspective on that and what you anticipate over the next year as things normalize.
A couple of comments I would make, and Max can jump in anywhere he'd like. First let me just talk a bit about what we're seeing in actually what was a spike in COVID-related claims in Japan in the third quarter. As we talked about, this was related to a policy that the Japanese government had of so-called deemed hospitalization, where if you were diagnosed with COVID, and even if you did not have severe symptoms and were being treated at home, you were eligible to receive claims on those COVID policies. The government changed their stance because it was clear that hospitalization rates, mortality, severity was all very low. It was much more common cold-like symptoms, what we're experiencing in the U.S.
They moved to more of a posture of, no, you're eligible for claims if you are more vulnerable, i.e., elderly, as in over the age of 65, or pregnant, or have other preexisting health conditions that could give rise to more acute hospitalization and severity. Those individuals are allowed to draw a claim on their policy, hospitalized or not, but everybody else can't do that. As a result, we've seen the incurred claims trend down, and it's trended down in the month of October versus September, November versus October, and even in the final week of November, it dipped down much more severely. All of our comments at the investor conference on the fourth quarter call about returning to a more normalized benefit ratio in Japan seem to be on pace as of our latest data.
Your question is a lag question of, over a period of less in the way of screening, diagnosis, doctor visits around cancer, aren't you anticipating larger cancer claims experience? So far, the simple answer is, in Japan, we have not seen that. There's speculation as to why that may be. It may be that of all of the possible concerns you have over your health in Japan, cancer is not one to fool around with, and therefore paying attention to cancer screening and cancer diagnosis was more of an acute or higher order activity in Japan. That's speculation. So far, we simply haven't seen it in incidence rates or severity. In the U.S., we've seen incidence rates climb to around 105%-110%. In other words, up around 5% or 10% over 2019 pre-COVID levels.
We appear to be seeing a little bit of that delayed or lagged incidence levels up. What's interesting, though, is both in Japan and in the U.S., it's not pressuring our benefit ratios, and the reason for that is hospitalization is down considerably. In other words, what transpired during COVID or accelerated was much more out of the hospital, at home treatment or outpatient treatment surrounding various types of cancer. That's both in the U.S. and Japan. Remember, our policies pay you not just on incidence, but also hospitalization, particularly when you're talking about advanced stages of cancer. What we're seeing in the U.S. and Japan is even though incidence rates in the U.S. have risen a bit, the hospitalization rates have come down, so the overall claims experience is remaining low. We continue to monitor and track it.
It is too early to declare some sort of victory or conclusion on this, that's what we're seeing so far.
I would add, the main component of total claims for cancer is hospitalization and surgery. It is not a first occurrence that mentioned. The other thing as well is that cancer is a disease of age. Just because somebody's getting COVID does not mean that they are now not going to get cancer. We actually do believe, and there's no medical evidence that cancer took a break from COVID, so to speak. The fact of the matter is that we do expect that diagnosis will continue to run relatively high in the near term. The first occurrence in those benefits, because essentially we didn't detect a lot of the cancers during COVID, and when we now detect them, it's not at stage 0 or 1. It might be, unfortunately, stage 3 or 4. We would expect that to continue.
That being said, the impact on our overall results for claims for cancer is still going to be somewhat muted, but a little bit above long-term trend is what we expect going into 2023. All of that is incorporated in our benefit ratio guidance.
It's interesting. We've always been viewed as a safe place to hide within the financial services industry if you're heading into.
Don't keep talking, guys, now.
Yeah. If you're heading into volatile conditions, the idea of a low beta morbidity-based company that has low asset leverage, and that's usually the assets that are most challenging when you head into weak economic conditions. That's always been the profile and the makeup of the company, whether you talk to a rating agency or a stock analyst, that doesn't matter, regulator, it's always that general view, and it's really true about our business model. What's interesting is the worst thing you ever could have handled, a company like ours, is a global pandemic. That's the one stress test, if you will, that we always ran that could be obviously of great concern. Here we had at least one form of test run.
We all know that the next pandemic is not going to look like the last pandemic, so you need to kind of always keep that in mind. What we found with our model is the number one impact of the pandemic is our sales model, okay? As we talked about earlier. Remember what happens to the business model of an insurance company when sales are down. When sales are down and because of a pandemic, claims are up, capital generation remains steady. Why? Because the number one use of capital, of good use of capital, is if you are growing the acquisition costs associated with putting policies on the books, paying the associated commissions. That is expensed at the time of spend for statutory or cash flow.
What happens is, what you may experience in the way of elevated claims, you are getting back in the way of lower sales and lower capital out the door because of those lower sales. Your capital and capital generation and cash flow remain strong. It's still proving out to be a quite resilient business model, the supplemental nature of what we do.
We have a couple of minutes left here. I know you guys laid out guidance at your investor day. There's some nuances around LDTI, the new accounting changes. I think you touched on some of it already, but was there anything else that you wanted to flesh out there with just the way the revenue and the margins are falling in?
It was really what I talked about, the impacts to Japan. Then also everybody should know that everything that's going forward, all the guidance that we've given is on a fully on an LDTI basis. I was joking internally saying that for me, legacy GAAP is retired on December 31st. On January 1st, it does not exist anymore. It is LDTI going forward and that's just the lay of the land and that's how we want to get going forward.
Got it. All right. Well, with that-
The good news is that if you have good morbidity margins and good underwriting, and good underwriting experience, LDTI, that new accounting flushes that out into your results in a very transparent way. We're blessed to have that. We have suffered from low interest rates, and that also gets flushed out as a source of earnings. The morbidity experience of the company has far and away outweighed any negative headwinds related to the low interest rate environment, and for that, we're very fortunate.
All right. We're just about of time, I'll stop it there. Thank you for joining. It was very helpful. Thank you all for being here.
Thank you for having us.
Thanks.