diff --git a/docs/api/openapi.yaml b/docs/api/openapi.yaml
index a02cb2e33..ce8e36ce1 100644
--- a/docs/api/openapi.yaml
+++ b/docs/api/openapi.yaml
@@ -6357,7 +6357,7 @@ paths:
         - Illness
       summary: Edit an illness episode (v1.18.1)
       description: Partial edit; omitted fields are left untouched. A re-parent must point at an owned, live episode (and
-        never the episode itself). Audits as `illness.episode.update`. Owner-scoped + born-gated.
+        never the episode itself). Audits as `illness.episode.update`. Owner-scoped + module-gated.
       parameters:
         - in: path
           name: id
@@ -6430,7 +6430,7 @@ paths:
         - Illness
       summary: Soft-delete an illness episode (v1.18.1)
       description: "Stamps `deletedAt` (tombstone). Idempotent — a re-delete is a no-op. Returns the `{ deleted: true }`
-        envelope (the cross-module DELETE shape). Audits as `illness.episode.delete`. Owner-scoped + born-gated."
+        envelope (the cross-module DELETE shape). Audits as `illness.episode.delete`. Owner-scoped + module-gated."
       parameters:
         - in: path
           name: id
@@ -6455,7 +6455,7 @@ paths:
       summary: Mark an illness episode recovered (v1.18.1)
       description: Stamps `resolvedAt` (defaults to 'now' when the body omits it). A CHRONIC_ONGOING episode has no recovery
         date and 422s with `errorCode:"illness.episode.chronic-no-resolve"`. Audits as `illness.episode.resolve`.
-        Owner-scoped + born-gated.
+        Owner-scoped + module-gated.
       parameters:
         - in: path
           name: id
@@ -6622,7 +6622,7 @@ paths:
         nadir, per-vital physiological returns, the headline recovery-gap, and any red flags. The findings derive from
         the user's OWN baseline (median ± MAD) over a contamination-guarded window — never a population constant.
         `status:\"insufficient\"` carries coverage + a reason. Retrospective ONLY — never a predictor or diagnoser.
-        Owner-scoped + born-gated."
+        Owner-scoped + module-gated."
       parameters:
         - in: path
           name: id
diff --git a/src/app/api/__tests__/module-route-gate-inventory.test.ts b/src/app/api/__tests__/module-route-gate-inventory.test.ts
index 57a5daca1..fd4e9bb17 100644
--- a/src/app/api/__tests__/module-route-gate-inventory.test.ts
+++ b/src/app/api/__tests__/module-route-gate-inventory.test.ts
@@ -78,12 +78,12 @@ const MODULE_ROUTE_TREES: ReadonlyArray<string> = [
   "src/app/api/biomarkers",
   "src/app/api/cycle",
   // v1.18.1 (W-B) — the illness/condition journal. Every `/api/illness/*`
-  // route gates on the born-gated `illness` module via the thin
+  // route gates on the `illness` module via the thin
   // `requireIllnessEnabled(...)` wrapper (which re-stamps the
   // illness-specific errorCode over `requireModuleEnabled("illness")`),
   // recognised below as a delegated gate. Walking the tree means a NEW
   // ungated illness route fails this test BY NAME rather than leaking the
-  // surface over a Bearer token when the account never opted in.
+  // surface over a Bearer token when the account turned the module off.
   "src/app/api/illness",
   "src/app/api/gamification",
   // v1.18.1 (D3) — medications graduated from CORE to a toggleable module.
diff --git a/src/app/api/biomarkers/route.ts b/src/app/api/biomarkers/route.ts
index a9c2a7ff5..b30c84be6 100644
--- a/src/app/api/biomarkers/route.ts
+++ b/src/app/api/biomarkers/route.ts
@@ -26,7 +26,7 @@ import { createBiomarkerSchema } from "@/lib/validations/biomarkers";
  * The Labs module toggle is a UX-only nav preference; the data is owner-scoped
  * and read by cross-feature surfaces (Vorsorge reminder resolution, the
  * doctor-report PDF) regardless of the toggle. Deliberate opt-out, in contrast
- * to the born-gated `/api/illness/*` routes.
+ * to the gated `/api/illness/*` routes.
  *
  * The catalog is the Labs feature's primary object: a marker is defined ONCE
  * (name, unit, reference bounds, optional context) and every later reading
diff --git a/src/app/api/labs/route.ts b/src/app/api/labs/route.ts
index 5afb9ac69..dce2e5a93 100644
--- a/src/app/api/labs/route.ts
+++ b/src/app/api/labs/route.ts
@@ -28,7 +28,7 @@ import {
 /**
  * v1.17.1 — structured lab-result store (`/api/labs`).
  *
- * Module gate: unlike `/api/illness/*` (born-gated, every route 403s when the
+ * Module gate: unlike `/api/illness/*` (gated, every route 403s when the
  * module is off), Labs is intentionally NOT server-gated. The Labs module
  * toggle is a UX-only nav/visibility preference — the data is always
  * owner-scoped and safe to read/write, and the Vorsorge lab-panel reminder
diff --git a/src/lib/doctor-report-data.ts b/src/lib/doctor-report-data.ts
index 647f0ae27..6e6b13c33 100644
--- a/src/lib/doctor-report-data.ts
+++ b/src/lib/doctor-report-data.ts
@@ -289,9 +289,9 @@ export interface DoctorReportData {
   }> | null;
   /**
    * v1.18.1 P4 — illness / condition episodes overlapping the report window.
-   * Populated ONLY when the `illness` module is enabled (born-gated opt-in);
-   * the user turned the journal on and is sharing it deliberately, so the
-   * privacy stance matches labs (ON when the module is on), not mood / cycle.
+   * Populated ONLY when the `illness` module is enabled (default-on, opt-out);
+   * the journal is on and shared deliberately, so the privacy stance matches
+   * labs (ON when the module is on), not mood / cycle.
    * Statistics + labels only — the free-text note is NEVER read here, so no
    * encrypted plaintext can leak into the report. Each entry feeds a FHIR
    * `Condition` (+ `Encounter`) and a PDF table row. Null/absent when the
@@ -1348,7 +1348,7 @@ export async function collectDoctorReportData(
   }
 
   // v1.18.1 P4 — illness / condition episodes overlapping the window. Gated
-  // on the illness module (born-gated opt-in): when off, no read, no section.
+  // on the illness module (default-on, opt-out): when off, no read, no section.
   // An episode overlaps when it began on or before the window end AND is
   // either still ongoing or resolved on or after the window start. Labels +
   // lifecycle + dates only — the encrypted note is never selected, so no
diff --git a/src/lib/illness/gate.ts b/src/lib/illness/gate.ts
index 280a1c8c6..16195cdf3 100644
--- a/src/lib/illness/gate.ts
+++ b/src/lib/illness/gate.ts
@@ -1,12 +1,12 @@
 /**
  * Illness / condition-journal feature gate (v1.18.1).
  *
- * The illness journal is BORN-GATED (opt-in / default-off) and resolves
- * its enabled-state through the module foundation — there is no per-domain
- * profile row and no second source of truth. `isIllnessEnabled` and the
- * `requireIllnessEnabled` 403 guard both delegate to the module gate's
- * `isModuleEnabled(userId, "illness")`, which (for a born-gated key) reads
- * an explicit `modulePreferencesJson.illness === true` AND the operator
+ * The illness journal is a standard optional module (default-on, opt-out)
+ * and resolves its enabled-state through the module foundation — there is
+ * no per-domain profile row and no second source of truth. `isIllnessEnabled`
+ * and the `requireIllnessEnabled` 403 guard both delegate to the module
+ * gate's `isModuleEnabled(userId, "illness")`, which reads the disabled
+ * allowlist (`modulePreferencesJson.illness !== false`) AND the operator
  * server-wide availability. This mirrors `src/lib/cycle/gate.ts` so every
  * `/api/illness/*` route gates identically.
  */
@@ -17,7 +17,7 @@ import { isModuleEnabled, requireModuleEnabled } from "@/lib/modules/gate";
 export const ILLNESS_DISABLED_ERROR_CODE = "illness.disabled";
 
 /**
- * Fully-resolved illness availability for an account: the born-gated opt-in
+ * Fully-resolved illness availability for an account: the per-user opt-out
  * AND the operator server-wide kill-switch, via the module foundation.
  */
 export function isIllnessEnabled(userId: string): Promise<boolean> {
@@ -34,8 +34,8 @@ export type IllnessGateResult =
 
 /**
  * Enforce the gate for an `/api/illness/*` route. Returns a 403
- * `illness.disabled` envelope when the account has not opted in (or the
- * operator turned the module off server-wide) — even with a valid Bearer
+ * `illness.disabled` envelope when the account has turned the module off
+ * (or the operator turned it off server-wide) — even with a valid Bearer
  * token. Delegates to `requireModuleEnabled` but re-stamps the
  * illness-specific `errorCode` so the iOS classifier branches cleanly.
  */
diff --git a/src/lib/modules/__tests__/gate.test.ts b/src/lib/modules/__tests__/gate.test.ts
index b4f72b2cf..83eab2394 100644
--- a/src/lib/modules/__tests__/gate.test.ts
+++ b/src/lib/modules/__tests__/gate.test.ts
@@ -78,14 +78,14 @@ describe("resolveModuleEnabled — disabled allowlist (default-on)", () => {
   });
 });
 
-describe("resolveModuleEnabled — born-gated module (illness, default-off)", () => {
-  it("is OFF when no preference is recorded (opt-in, not default-on)", () => {
+describe("resolveModuleEnabled — illness module (default-on, opt-out)", () => {
+  it("is ON when no preference is recorded (default-on like its siblings)", () => {
     expect(resolveModuleEnabled("illness", inputs(), true, ALL_AVAILABLE)).toBe(
-      false,
+      true,
     );
   });
 
-  it("is ON only on an explicit true", () => {
+  it("stays ON on an explicit true", () => {
     expect(
       resolveModuleEnabled(
         "illness",
@@ -96,7 +96,7 @@ describe("resolveModuleEnabled — born-gated module (illness, default-off)", ()
     ).toBe(true);
   });
 
-  it("stays OFF on an explicit false", () => {
+  it("is OFF only on an explicit false (opt-out)", () => {
     expect(
       resolveModuleEnabled(
         "illness",
@@ -107,7 +107,7 @@ describe("resolveModuleEnabled — born-gated module (illness, default-off)", ()
     ).toBe(false);
   });
 
-  it("operator-off short-circuits even when the user opted in", () => {
+  it("operator-off short-circuits even when the user enabled it", () => {
     expect(
       resolveModuleEnabled(
         "illness",
@@ -118,9 +118,9 @@ describe("resolveModuleEnabled — born-gated module (illness, default-off)", ()
     ).toBe(false);
   });
 
-  it("does not affect sibling default-on modules", () => {
+  it("matches its sibling default-on modules", () => {
     const i = inputs({ modulePreferences: {} });
-    expect(resolveModuleEnabled("illness", i, true, ALL_AVAILABLE)).toBe(false);
+    expect(resolveModuleEnabled("illness", i, true, ALL_AVAILABLE)).toBe(true);
     expect(resolveModuleEnabled("mood", i, true, ALL_AVAILABLE)).toBe(true);
     expect(resolveModuleEnabled("labs", i, true, ALL_AVAILABLE)).toBe(true);
   });
diff --git a/src/lib/modules/gate.ts b/src/lib/modules/gate.ts
index 3e1da491b..34a4797a9 100644
--- a/src/lib/modules/gate.ts
+++ b/src/lib/modules/gate.ts
@@ -53,12 +53,7 @@ import {
   getOperatorModuleAvailability,
   type OperatorModuleAvailability,
 } from "./operator-availability";
-import {
-  MODULE_KEYS,
-  isBornGatedModule,
-  moduleDelegatesTo,
-  type ModuleKey,
-} from "./registry";
+import { MODULE_KEYS, moduleDelegatesTo, type ModuleKey } from "./registry";
 
 export {
   getOperatorModuleAvailability,
@@ -147,13 +142,6 @@ export function resolveModuleEnabled(
     return assistantCoach && !inputs.disableCoach;
   }
 
-  if (isBornGatedModule(key)) {
-    // BORN-GATED (opt-in / default-off): inverse of the disabled allowlist.
-    // The module stays OFF until the account explicitly enables it — only a
-    // literal `true` turns it on, so the surface never appears unbidden.
-    return inputs.modulePreferences[key] === true;
-  }
-
   // Disabled allowlist: only an explicit `false` turns the module off.
   return inputs.modulePreferences[key] !== false;
 }
diff --git a/src/lib/modules/registry.ts b/src/lib/modules/registry.ts
index 90f276002..704962a2f 100644
--- a/src/lib/modules/registry.ts
+++ b/src/lib/modules/registry.ts
@@ -73,17 +73,6 @@ export interface ModuleDefinition {
    * link; `labelKey` names the destination ("Account", "Coach settings").
    */
   managedAt?: { href: string; labelKey: string };
-  /**
-   * v1.18.1 — BORN-GATED (opt-in / default-off). A born-gated module is
-   * the inverse of the standard disabled-allowlist: it stays OFF until the
-   * account explicitly enables it (`modulePreferencesJson[key] === true`).
-   * Used for new optional verticals (the illness/condition journal) that
-   * ship dark and only appear once the user opts in from the Modules hub.
-   * The gate's `false`-disables contract still holds — an explicit `false`
-   * (or simply the absent default) keeps it off — but here ONLY an explicit
-   * `true` turns it on, so the surface never appears unbidden.
-   */
-  bornGated?: boolean;
 }
 
 /**
@@ -196,9 +185,6 @@ export const MODULE_REGISTRY: Readonly<Record<ModuleKey, ModuleDefinition>> =
       labelKey: "modules.illness.label",
       descriptionKey: "modules.illness.description",
       category: "tracking",
-      // Ships dark — only appears once the account opts in from the
-      // Modules hub. Default-off, no nag, retrospective-only.
-      bornGated: true,
     },
     sleep: {
       key: "sleep",
@@ -267,12 +253,3 @@ export function isModuleKey(key: string): key is ModuleKey {
 export function moduleDelegatesTo(key: ModuleKey): ModuleDelegation | undefined {
   return MODULE_REGISTRY[key].delegatesTo;
 }
-
-/**
- * v1.18.1 — true for a born-gated (opt-in / default-off) module. The gate
- * flips its default from on to off for these keys: they require an explicit
- * `modulePreferencesJson[key] === true` to enable.
- */
-export function isBornGatedModule(key: ModuleKey): boolean {
-  return MODULE_REGISTRY[key].bornGated === true;
-}
diff --git a/src/lib/openapi/routes/illness.ts b/src/lib/openapi/routes/illness.ts
index 1c9c9d62c..1e03d0f50 100644
--- a/src/lib/openapi/routes/illness.ts
+++ b/src/lib/openapi/routes/illness.ts
@@ -9,9 +9,9 @@
  * carry; iOS renders the DTO, it never recomputes it).
  *
  * The journal is a CONDITION journal, retrospective-only — never a
- * predictor/diagnoser. Every route is born-gated: a non-opted-in account (or
- * an operator-disabled instance) 403s with `errorCode:"illness.disabled"`
- * even with a valid Bearer token.
+ * predictor/diagnoser. Every route is module-gated: an account that turned
+ * the module off (or an operator-disabled instance) 403s with
+ * `errorCode:"illness.disabled"` even with a valid Bearer token.
  */
 import type { ZodOpenApiObject } from "zod-openapi";
 import { z } from "zod/v4";
@@ -342,7 +342,7 @@ export const illnessPaths: NonNullable<ZodOpenApiObject["paths"]> = {
       tags: ["Illness"],
       summary: "Edit an illness episode (v1.18.1)",
       description:
-        "Partial edit; omitted fields are left untouched. A re-parent must point at an owned, live episode (and never the episode itself). Audits as `illness.episode.update`. Owner-scoped + born-gated.",
+        "Partial edit; omitted fields are left untouched. A re-parent must point at an owned, live episode (and never the episode itself). Audits as `illness.episode.update`. Owner-scoped + module-gated.",
       requestParams: { path: z.object({ id: z.string() }) },
       requestBody: {
         required: true,
@@ -370,7 +370,7 @@ export const illnessPaths: NonNullable<ZodOpenApiObject["paths"]> = {
       tags: ["Illness"],
       summary: "Soft-delete an illness episode (v1.18.1)",
       description:
-        "Stamps `deletedAt` (tombstone). Idempotent — a re-delete is a no-op. Returns the `{ deleted: true }` envelope (the cross-module DELETE shape). Audits as `illness.episode.delete`. Owner-scoped + born-gated.",
+        "Stamps `deletedAt` (tombstone). Idempotent — a re-delete is a no-op. Returns the `{ deleted: true }` envelope (the cross-module DELETE shape). Audits as `illness.episode.delete`. Owner-scoped + module-gated.",
       requestParams: { path: z.object({ id: z.string() }) },
       responses: {
         "200": {
@@ -394,7 +394,7 @@ export const illnessPaths: NonNullable<ZodOpenApiObject["paths"]> = {
       tags: ["Illness"],
       summary: "Mark an illness episode recovered (v1.18.1)",
       description:
-        "Stamps `resolvedAt` (defaults to 'now' when the body omits it). A CHRONIC_ONGOING episode has no recovery date and 422s with `errorCode:\"illness.episode.chronic-no-resolve\"`. Audits as `illness.episode.resolve`. Owner-scoped + born-gated.",
+        "Stamps `resolvedAt` (defaults to 'now' when the body omits it). A CHRONIC_ONGOING episode has no recovery date and 422s with `errorCode:\"illness.episode.chronic-no-resolve\"`. Audits as `illness.episode.resolve`. Owner-scoped + module-gated.",
       requestParams: { path: z.object({ id: z.string() }) },
       requestBody: {
         required: false,
@@ -491,7 +491,7 @@ export const illnessPaths: NonNullable<ZodOpenApiObject["paths"]> = {
       tags: ["Illness"],
       summary: "Per-episode retrospective correlation (v1.18.1)",
       description:
-        "Returns the coverage-gated `Derived<T>` correlation for one episode: the pre-onset anomaly scan, the nadir, per-vital physiological returns, the headline recovery-gap, and any red flags. The findings derive from the user's OWN baseline (median ± MAD) over a contamination-guarded window — never a population constant. `status:\"insufficient\"` carries coverage + a reason. Retrospective ONLY — never a predictor or diagnoser. Owner-scoped + born-gated.",
+        "Returns the coverage-gated `Derived<T>` correlation for one episode: the pre-onset anomaly scan, the nadir, per-vital physiological returns, the headline recovery-gap, and any red flags. The findings derive from the user's OWN baseline (median ± MAD) over a contamination-guarded window — never a population constant. `status:\"insufficient\"` carries coverage + a reason. Retrospective ONLY — never a predictor or diagnoser. Owner-scoped + module-gated.",
       requestParams: { path: z.object({ id: z.string() }) },
       responses: {
         "200": {