The acceptance of applications for U.S. dollar-denominated ordinary whole life insurance from high net worth foreign nationals has been the core business for the Company for the past 30 years. Through CICA, the Company is a significant participant in this market. Our niche allows the Company to participate in a marketplace where the policies are typically large face amounts, the premiums are paid annually, the persistency is high compared to U.S. policies, the mortality as good as or better than that experienced in the United States, the caliber of the marketers from whom applications are received for consideration is higher and more professional than that typically seen in the U.S., and there is no advancing of commissions to producers. Overall, we expect our international operations to continue to expand. The number of independent marketers contracted has grown over the past few years. Historically, the majority of such business was focused on Central and South America. The Company receives applications from virtually every country in those regions. Overall, foreign business made up more than 86% of CICA's premium revenues in 2003.
The ability of state insurance regulators to limit the timing and size of rate increases also impacts the Company's ability to stay ahead of the claims curve on certain types of accident and health policies. Due to the failure of rate increases and the non-renewal of certain blocks as described above to reach the level of profitability to that experienced on the Company's life segments, coupled with the fact that the accident and health business is not the Company's core line of business, management determined in late 2003 to seek a buyer for the block of accident and health business. In early 2004, management reached an agreement to transfer all of the in force accident and health business to a Texas-domiciled reinsurer effective January 1, 2004. The consideration for the transfer, which will initially be accomplished through a 100% coinsurance arrangement until the various state insurance departments can approve an assumption reinsurance agreement, will be a participation in any future profits on the book of business over a 10-year period. Management estimates that this action will result in a decrease of approximately $14.7 million of annual premium income but should improve long-term profitability. We expect that overhead savings of more than $1.0 million annually will be achieved through the transfer of this business. (See Note 9 of the "Notes to Consolidated Financial Statements" for an analysis of the results of the Accident and Health segment.)
Table IV in Item 1 above, illustrates that during the past five years the ratio of commissions, underwriting and operating expenses to insurance premiums has ranged from 38.0% to 47.7% and the ratio of commissions, underwriting and operating expenses, policy reserves increases, policyholder benefits and dividends to policyholders to insurance premiums has ranged from 114.7% to 119.2%. Table VIII also shows that the ratio of net investment income to mean amount of invested assets has varied from 1999 through 2002 6.6% to 6.8%. The 2003 5.7% represents the impact of the low interest environment. As set forth above in Management's Discussion and Analysis of Financial Condition and Results of Operations, death benefits for the years ended December 31, 2003, 2002 and 2001 were $6,398,627, $6,599,914 and $5,613,782, respectively with $712,052 of the 2002 increase in death benefits related to the acquisitions of Combined and Lifeline and $320,213 of the 2003 increase in death benefits related to the acquisitions of First Alliance and Mid-American.