This simple worksheet lets you assess the income needed to sustain your current standard of living should you become disabled and unable to work. This should not be viewed as a comprehensive assessment. For more information, talk to your human resources administrator or a qualified insurance professional.

Enter only numbers, no commas or dollar signs.

Monthly Income Available
Income from current group disability coverage	$
Income from current individual disability coverage	$
Income from spouse or other family members	$
Monthly investment income	$
Monthly Expenses
Mortgage (including property tax) or rent	$
Homeowner’s or renter’s insurance	$
Car payments and insurance	$
Utilities	$
Food and clothing	$
Child care expenses	$
Bank loan and credit card payments	$
Medical expenses	$
Health insurance premiums *	$
Insurance premiums (life, disability, dental, etc.)	$
Savings, investment and retirement contributions	$
Home maintenance costs	$
Other (education, entertainment, etc.)	$

* If you become disabled, you can generally maintain your group health insurance coverage, but your employer may no longer contribute toward the premium. Ask your human resources department what the full cost of your health insurance premium would be if you become disabled.

Share this