The same lead can only exist once in a list. If you have duplicates in your system, meaning that technically they are different leads, they can both be in the same list, but Marketo should only email the address once in a flow.
If you were to try adding this lead to the list a second time, I believe the activity on that record would show something like "Action skipped: already member of list"
If you have the rule
"Each Lead Can Run Through The Flow Everytime", everytime you batch the campaign, all leads on the list will enter the flow even if they have already received it. Marketo will still recognize that the lead is alreay on this list in this scenario as well.