You are given a text that consists of multiple sentences. Your task is to perform abstractive summarization on this text. Use your understanding of the content to express the main ideas and crucial details in a shorter, coherent, and natural sounding text. 
Text: With the pandemic conditions continuing to evolve, I'm proud of our response over the last year.
I am also grateful to our team of employees and sales representatives who have empowered Aflac to adapt to what has been a very challenging time for everyone.
During the third quarter, we saw a rise and then a decline in COVID cases and hospitalizations in both the United States and in Japan, but to varying degrees.
With that in mind, I continue to address our employees in a way that's similar to how with my own family.
I'm keeping them informed in updates from the medical community and encourage them to get the COVID-19 vaccine because I want people to avoid being sick or even worse being a casualty due to this pandemic.
As we entered the fourth quarter, when the weather gets colder and indoor gatherings increase, the recovery from the pandemic remains uncertain, and we must remain diligent.
For the third quarter, adjusted earnings per diluted share, excluding foreign currency impact increased 10.1% for the quarter and 20.1% for the year.
These results are largely driven by lower-than-expected benefit ratios and higher net investment income, primarily in Japan.
Looking at the operations in Japan in the third quarter, Aflac Japan generated solid overall financial results as reflected in the profit margin of 26.3%, which was above the outlook range provided at our financial analyst briefing for 2020.
As Max will explain in a few moments, Aflac Japan has reported very strong premium persistency of 94.5%.
Aflac Japan sales were essentially flat for the quarter.
Sales for the first nine months of this year were approximately 66% of 2019 level.
We continue to navigate evolving pandemic conditions in Japan, which include widespread state of emergencies that extended to multiple prefectures and persisted through the third quarter.
These states of emergency in Japan are much less restrictive and more limited in scope than lockdowns in other countries, but they have impacted face-to-face sales opportunities.
As we entered the fourth quarter, the ability to meet face-to-face with customers appears to be improving somewhat gradually.
And the degree to which our ability to meet face-to-face continues to improve with a very key driver in the recovery of our sales.
We were encouraged by the September launch of our new nursing care insurance in Japan, which we view as another opportunity to meet the needs of certain consumers.
However, it's still very early in the launch of this new product to determine the potential of the nursing care insurance.
In addition, Aflac Japan continues to work to strengthen the alliance with Japan Post, which resumed proactive sales of the cancer insurance on April 1.
We expect continued collaboration to further position both companies for the long-term growth and a gradual improvement of Japan Post cancer insurance sales in the intermediate term.
Now turning to Aflac U.S.
We saw a strong profit margin of 22.2%.
This result was driven by lower incurred benefits and higher adjusted net investment income, particularly offset by the higher adjusted expenses.
Aflac U.S. also continued to have strong premium persistency of nearly 80%.
Sales increased 35% for the quarter and are at approximately 78% of sales for the first nine months of 2019.
These sales results reflect what we believe are improving pandemic conditions in the United States, allowing us more face-to-face meetings and enrollments than prior periods.
In the U.S., small businesses have gained some incremental ground toward recovery, which we expect to continue gradually.
Within the challenging small business and labor markets, we continue to make investments in developments of traditional independent sales agents that make up about 53% of our sales as of the third quarter of 2021.
At the same time, larger businesses appear to be more resilient, given their traditional reliance on online self-enrollment tools, and we continue to invest in the group platform.
Group business, which is being driven by broker performance is performing very well.
Excluding our acquired platforms, group sales have generated a year-to-date sales increase of 14% over the same period for 2019.
As we enter historically higher enrollment periods in the United States, we remain focused on being able to sell and service customers, whether in person or virtually.
With an eye toward responding to the needs of consumers, businesses and our distribution, we continue to build out the U.S. portfolio with Aflac network Dental and Vision premier life and disability.
These new lines modestly impact the topline in the short term.
These new products in combination with our core products, better position Aflac U.S. for future long-term success.
Pandemic conditions have served to fuel our long-standing strategy of being where people want to purchase insurance in both the United States and in Japan.
And while face-to-face sales remains the most effective way for us to convey the financial protection only Aflac products provide, the pandemic has clearly demonstrated the need for virtual avenues to help us reach potential customers.
We have continued to invest in tools for our distribution in both countries and to integrate these investments into our operations.
As always, we place significant importance on continuing to achieve strong capital ratios in the U.S. and Japan on behalf of our policyholders and investors.
We remain committed to prudent liquidity and capital management.
With the fourth quarter declaration, 2021 will mark the 39th consecutive year of dividend increases.
Our dividend track record is supported by the strength of our capital and cash flows.
At the same time, we will continue to be tactical in our share repurchase and focus on integrating the growth investments we've made in our platform.
We are well positioned as we work toward achieving long-term growth, while also ensuring we deliver on our promise to our policyholders.
By doing so, we look to emerge from this period in continued position of strength and leadership and look forward to sharing more about our strategic and financial priorities at the financial analyst briefing on November 16, 2021.
Now let me turn the program over to Fred.
Recognizing we have our analyst and investor briefing scheduled in the next few weeks.
I'll keep my comments brief before handing off to Max on the quarter's financial results.
Beginning with Aflac Japan, as Dan noted, it was an unusual quarter with the states of emergency declarations across most of the country.
Declarations are triggered in Japan by, among other things, a combination of rates of infection and hospital utilization by prefecture.
The precise impact is difficult to calculate, but the practical implications include reduced face-to-face consultations, limited access to on-site workers and payroll solicitation, reduced foot traffic to the roughly 400 owned and affiliated retail shops that we sell through and restricted travel between prefectures, which further constrains sales professionals.
When looking at claims experience through the third quarter and since inception of the virus, Aflac Japan's COVID impact has totaled approximately 31,000 claimants with incurred claims of JPY5.6 billion.
We expect conditions to improve and remain focused on what we can control, including product development and advancing our business model.
Our medical product EVER Prime continues to do well with medical sales up roughly 14% in the quarter and 36% year-to-date over the same period in 2020.
Our market share has improved, but we're still at roughly 85% of the medical sales enjoyed in 2019, which was also a medical product refresh year.
So pandemic conditions in the quarter are having an impact.
Regarding our nursing care product.
Since our late September launch, we have sold nearly 10,000 policies.
This is a strong start, but within our expectations, given the marketing support put behind the product.
From a risk perspective, this is a supplemental product aligned with coverage provided by the Japanese government and targeting the mass market.
Benefits are, therefore, less rich and capped, both in amount and duration.
The product is designed for protection versus savings with modest interest rate sensitivity.
In summary, the product has a similar risk profile to our existing third sector products.
We continue the development of noninsurance services that wrap our cancer and now nursing care product offerings.
This has become more common among the large domestic insurers and we see these services as important for both defending and building our market share.
Turning to the U.S., pandemic conditions remain at elevated levels with the spread of the Delta strain of the virus.
As of the end of the third quarter, Aflac U.S. COVID claimants since inception of the virus, has totaled approximately 79,000 with incurred claims of $135 million.
Dan covered overall U.S. sales conditions.
I'll focus my comments specifically on our buy-to-build growth platforms.
Our 2021 Dental and Vision strategy can be summed up as a year of launch, learn and adjust.
This quarter, we processed over 1,600 cases, up 30% over the second quarter, as we roll out training and development to agents and launch in additional states.
We are focused on small- and medium-sized businesses with sold cases averaging around 95 employees.
Looking forward into 2022, we continue building out our dental network and readying the platform for increased volumes as we move upmarket and introduce a direct-to-consumer individual product.
Our premier life and disability team successfully renewed 100% of their current accounts, a testimony to their high-quality service model.
We are preparing to launch with Connecticut administering benefits for their statewide paid family and medical leave program in 2022.
This is an administrative-only contract leveraging our acquired leave management platform.
With respect to our e-commerce initiative, Aflac Direct, we currently offer products in 46 states.
We are actively building out a licensed call center and currently have 14 licensed agents.
The call center platform is in the early days of building and augments our digital-only conversion rates as well as reduces operational dependency on call center vendors.
In the third quarter, these three platforms accounted for roughly 13% of sales and are expected to build as a percentage of sales and earned premium in the coming years.
Before handing off to Max, a few comments on operations.
In Japan, we continue to drive volume through our online sales solution.
Year-to-date, we have processed over 38,000 online applications with September being our largest month since launching the capability.
We are pushing forward on technology and digital modernization and are sizing the investment required to streamline our policyholder services platform.
This is the largest operating platform in Japan and a key to driving down our long-term expense ratio.
In the U.S., our premier life and disability platform completed a successful transition this month from Zurich on time, on budget and without client or customer disruption.
We are focused on migrating our voluntary business to a new group administration platform and building out critical data connections with leading benefit administration and HR systems.
The goal is to ensure ease of doing business, smooth onboarding and renewals and quality service and analytics.
When looking at our Japan and U.S. expense ratios going forward, we continue with critical platform development despite a period of weaker revenue.
We expect to stay within previously guided ranges for expense ratios recognizing prolonged pandemic conditions require recalibrating the precise trajectory and timeline for reaching our ultimate targets.
Finally, at Aflac Global Investments, performance remains strong.
We continue to advance our sustainable investing platform and recently refreshed our strategic asset allocation work.
Our team will dive deeper into operations and strategic execution at next month's Analyst and Investor Briefing.
Let me now turn things over to Max to cover financial performance.
For the third quarter, adjusted earnings per share increased 10.1% to $1.53, with a $0.02 negative impact from foreign exchange in the quarter.
This strong performance for the quarter was largely driven by lower claims utilization due to pandemic conditions, especially in Japan.
Variable investment income ran $0.11 above our long-term return expectations.
Adjusted book value per share, including foreign currency translation gains and losses, grew 10.1%.
And the adjusted ROE, excluding the foreign currency impact, was a strong 16.2%, a significant spread to our cost of capital.
Starting with our Japan segment.
Total earned premium for the quarter declined 4%, reflecting first sector policies paid-up impacts, while earned premium for our third sector products was down 2.6% due to recent low sales volumes.
Policy count in-force, which we view as a better measure of our overall business growth declined 1.8%.
Japan's total benefit ratio came in at 66.1% for the quarter, down 520 basis points year-over-year, and the third sector benefit ratio was 55%, down 670 basis points year-over-year.
We experienced a greater-than-normal IBNR release in our third sector block, as experience continues to come in favorable relative to initial reserving.
Utilization continues to be constrained by pandemic conditions, and we now have more than a year's worth of pandemic data.
And with that, our model output is more refined, leading to increased releases.
Adjusting for greater than normal IBNR releases and in-period experience, we estimate that our normalized benefit ratio for the third quarter to be 68.7%.
Persistency remained strong with a rate of 94.5%, down 50 basis points year-over-year.
Consistent with past refreshed product launches, we have experienced a slight uptick in lapse rates on our medical product, as policyholders look to update their coverage.
Our expense ratio in Japan was 21.4%, down 30 basis points year-over-year.
Constrained business activity lowered our expenses in Q3, which we view to be a temporary phenomenon.
We generally expect increased spending on key initiatives to continue and especially in Q4, as we tend to see some seasonality in spending and booking of projects.
Adjusted net investment income increased 19.7% in yen terms, primarily driven by favorable returns on our growing private equity portfolio and lower hedge costs, partially offset by lower reinvestment yield on our fixed rate portfolio.
The pre-tax margin for Japan in the quarter was 26.3%, up 690 basis points year-over-year, a very good result for the quarter.
This quarter's strong financial results lead us to expect the full year benefit ratio for Japan to be below the 3-year guidance range of 68.5% to 71% given at FAB.
And the pre-tax margin to be above the 20.5% to 22.5% range given at -- for the full year 2021.
Turning to U.S. results.
Net earned premium was down 1%, as lower sales results during the pandemic continue to have an impact on our earned premium.
Persistency improved 110 basis points to 79.9%, 70 basis points of which are from lower sales, as first year lapse rates are roughly twice the level of in-force lapse rates.
In addition, there still remains about 40 basis points of positive impact from emergency orders.
Our total benefit ratio in the U.S. came in lower than expected at 45.1% or 320 basis points lower than Q3 2020, which itself was heavily impacted by the initial pandemic.
Lower and deferred claims utilization impacts our IBNR held for incurred claims within a year.
And as we get more data, our long-term models increased reliance on raw data leading to IBNR releases.
This quarter, they amounted to a 3.5 percentage points impact on the benefit ratio, which leads to an underlying benefit ratio, excluding IBNR releases of 48.6%.
We expect the benefit ratio to increase gradually throughout the remainder of the year with the resumption of normal activity in our communities and by our policyholders.
For the full year, we now expect our benefit ratio to be in the range of 43% to 46% versus original guidance of 48% to 51%.
Our expense ratio in the U.S. was 38.9%, up 170 basis points year-over-year, but with a lot of moving parts.
Weaker sales performance negatively impacts revenue, however, the impact to our expense ratio is largely offset by lower DAC expense.
Higher advertising spend increased the expense ratio by 40 basis points.
Our continued build-out of growth initiatives, group life and disability, network dental and vision and direct-to-consumer contributed to a 260 basis points increase to the ratio when isolating these investments.
These important strategic growth investments are somewhat offset by our efforts to lower our core operating expenses, as we strive toward being the low-cost producer in the voluntary benefits space.
Net-net, despite a lot of moving parts, Q3 expenses are tracking according to plan.
In the quarter, we also incurred $7.8 million of integration expenses, not included in adjusted earnings associated with recent acquisitions.
Adjusted net investment income in the U.S. was up 9.1%, mainly driven by favorable variable investment income in the quarter.
Profitability in the U.S. segment remained strong with a pre-tax margin of 22.2%, with a low benefit ratio as the core driver.
With nine months now in the books, we are increasing our pre-tax expectation for the full year.
Initial expectations were for us to be toward the low end of 16% to 19%.
We now expect to end up above the range indicated at FAB 2020.
In our Corporate segment, we recorded a pre-tax loss of $41 million, as adjusted net investment income was down $12 million versus last year due to low interest rates at the short end of the yield curve and change in value of certain tax credit investments.
These tax credit investments run through the corporate net investment income line for U.S. GAAP purposes with an associated credit to the tax line.
The net impact to our bottom line was a positive $5 million in the quarter.
To date, these investments are performing well and in line with expectations.
In the fourth quarter, we do expect a significant tax credit investment to fund, which will bring some volatility to the corporate NII line as well as an offsetting credit to the tax line.
Our capital position remains strong, and we ended the quarter with an SMR in Japan of north of 900% and an RBC north of 600% in Aflac Columbus.
Unencumbered holding company liquidity stood at $4.2 billion, $1.8 billion above our minimum balance.
Leverage, which includes the sustainability bond issued earlier this year, remains at a comfortable 22.6% in the middle of our leverage corridor of 20% to 25%.
In the quarter, we repurchased $525 million of our own stock and paid dividends of $220 million, offering good relative IRR on these capital deployments.
We will continue to be flexible and tactical in how we manage the balance sheet and deploy capital in order to drive strong risk-adjusted return on equity with a meaningful spread to our cost of capital.
Finally, I would like to mention that we will begin to expand our disclosures around the adoption of LDTI in our Form 10-Q and at FAB.
At a high level, we do not see this accounting adoption as an economic event with no impact to our regulatory financials or capital base.
There will be no change to how we manage the company, cash flows or capital.
With that, I'll hand it over to David to begin.

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q3 adjusted earnings per share $1.53.

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